Abstract P1021: Leadless Pacemakers: A Systematic Review on Superior Alternative for Cardiac Support in Post-Valvular Interventional Patients

Abstract

Background: Around 10% of patients need a permanent pacemaker due to conduction issues in heart post-valvular interventions. The transvenous pacemaker has many complications compared to novel Leadless pacemaker(LPM) implantation. Objective: The main aim of this review is to compare the outcomes between conventional transvenous pacemakers and leadless pacemaker implantation after valvular intervention. Method: We conducted a comprehensive search of PubMed and ScienceDirect databases for relevant studies published between 2019 and 2024 using the keywords- pacemaker implantation and valvular intervention. Studies available in full text and in English language were included. After removing duplicates using the Rayyan tool, the remaining studies were screened and selected based on predefined inclusion criteria. Eligible studies included retrospective analyses of patients aged over 40 years, with indications for leadless pacemaker implantation such as atrial fibrillation, sick sinus syndrome, complete heart block, or complications following pacemaker implantation. Patients who had previously undergone implantations were excluded. We performed a qualitative synthesis of data to note the comparisons. Result: A total of 9 studies were included, comprising 10,776 patients, of whom 1121 underwent LPM implantation and 9655 received conventional transvenous pacemakers. Indications for LPM following valvular interventions included atrial fibrillation(n=24), complete heart block(n=20), bradycardia(n=26), high-degree atrioventricular (AV) block(n=30), and left bundle branch block(n=9). For conventional transvenous pacemakers, complete heart block(n=24) and high-degree AV block(n=7) were the primary indications. Compared to LPM, patients with conventional pacemakers reported more complications like pocket formation, pericardial effusion, pneumothorax, and infections, along with increased hospital stay duration. A few patients with LPM suffered from device-related complications like device dislodgement and device thrombus formation. Conclusion: The above findings suggest that while both the devices showed some device related risks, LPMs presented with fewer overall adverse outcomes, and thus, may be a safer alternative than conventional pacemakers. There is insufficient data on the use of LPM after valvular interventions. Further studies are required to fully assess the risks and benefits of LPM and their usage in patients of conduction abnormalities after valvular interventions.