• Marco Schiavone, Annalisa Filtz, Alessio Gasperetti, Alexander Breitenstein, Pietro Palmisano, Gianfranco Mitacchione, Simone Gulletta, Gian Battista Chierchia, Elisabetta Montemerlo, Giovanni Statuto, Giulia Russo, Michela Casella, Francesco Vitali, Patrizio Mazzone, Daniel Hofer, Gianmarco Arabia, Fabrizio Tundo, Diego Ruggiero, Nicolai Fierro, Massimo Moltrasio, Matteo Bertini, Antonio Dello Russo, Ennio C L Pisanò, Paolo Della Bella, Giovanni Rovaris, Carlo de Asmundis, Mauro Biffi, Antonio Curnis, Claudio Tondo, Ardan M Saguner, and Giovanni B Forleo.
• Cardiology Unit, Luigi Sacco University Hospital, 20131 Milan, Italy.
• Medicina (Kaunas). 2022 Dec 28; 59 (1).

AbstractBackground. Data on leadless pacemaker (LPM) implantation in an emergency setting are currently lacking. Objective. We aimed to investigate the feasibility of LPM implantation for emergency bradyarrhythmia, in patients referred for urgent PM implantation, in a large, multicenter, real-world cohort of LPM recipients. Methods. Two cohorts of LPM patients, stratified according to the LPM implantation scenario (patients admitted from the emergency department (ED+) vs. elective patients (ED−)) were retrieved from the iLEAPER registry. The primary outcome of the study was a comparison of the peri-procedural complications between the groups. The rates of peri-procedural characteristics (overall procedural and fluoroscopic duration) were deemed secondary outcomes. Results. A total of 1154 patients were enrolled in this project, with patients implanted due to an urgent bradyarrhythmia (ED+) representing 6.2% of the entire cohort. Slow atrial fibrillation and complete + advanced atrioventricular blocks were more frequent in the ED+ cohort (76.3% for ED+ vs. 49.7% for ED−, p = 0.025; 37.5% vs. 27.3%, p = 0.027, respectively). The overall procedural times were longer in the ED+ cohort (60 (45−80) mins vs. 50 (40−65) mins, p < 0.001), showing higher rates of temporary pacing (94.4% for ED+ vs. 28.9% for ED−, p < 0.001). Emergency LPM implantation was not correlated with an increase in the rate of major complications compared to the control group (6.9% ED+ vs. 4.2% ED−, p = 0.244). Conclusion. LPM implantation is a feasible procedure for the treatment of severe bradyarrhythmia in an urgent setting. Urgent LPM implantation was not correlated with an increase in the rate of major complications compared to the control group, but it was associated with longer procedural times.

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