Gulletta Simone, Schiavone Marco, Gasperetti Alessio, Breitenstein Alexander, Palmisano Pietro, Mitacchione Gianfranco, Chierchia Gian Battista, Montemerlo Elisabetta, Statuto Giovanni, Russo Giulia, Casella Michela, Vitali Francesco, Mazzone Patrizio, Hofer Daniel, Arabia Gianmarco, Moltrasio Massimo, Lipartiti Felicia, Fierro Nicolai, Bertini Matteo, Dello Russo Antonio, Pisanò Ennio C L, Biffi Mauro, Rovaris Giovanni, de Asmundis Carlo, Tondo Claudio, Curnis Antonio, Della Bella Paolo, Saguner Ardan M, Forleo Giovanni B
Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy.
Cardiology Unit, Luigi Sacco University Hospital, Milan, IT, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, IT, Italy.
Int J Cardiol. 2023 Jan 15;371:197-203. doi: 10.1016/j.ijcard.2022.09.026. Epub 2022 Sep 15.
Age-related differences on leadless pacemaker (LP) are poorly described. Aim of this study was to compare clinical indications, periprocedural and mid-term device-associated outcomes in a large real-world cohort of LP patients, stratified by age at implantation.
Two cohorts of younger and older patients (≤50 and > 50 years old) were retrieved from the iLEAPER registry. The primary outcome was to compare the underlying indication why a LP was preferred over a transvenous PM across the two cohorts. Rates of peri-procedural and mid-term follow-up major complications as well as LP electrical performance were deemed secondary outcomes.
1154 patients were enrolled, with younger patients representing 6.2% of the entire cohort. Infective and vascular concerns were the most frequent characteristics that led to a LP implantation in the older cohort (45.8% vs 67.7%, p < 0.001; 4.2% vs 16.4%, p = 0.006), while patient preference was the leading cause to choose a LP in the younger (47.2% vs 5.6%, p < 0.001). Median overall procedural (52 [40-70] vs 50 [40-65] mins) and fluoroscopy time were similar in both groups. 4.3% of patients experienced periprocedural complications, without differences among groups. Threshold values were higher in the younger, both at discharge and at last follow-up (0.63 [0.5-0.9] vs 0.5 [0.38-0-7] V, p = 0.004).
When considering LP indications, patient preference was more common in younger, while infective and vascular concerns were more frequent in the older cohort. Rates of device-related complications did not differ significantly. Younger patients tended to have a slightly higher pacing threshold at mid-term follow-up.
关于无导线起搏器（LP）的年龄相关差异描述较少。本研究的目的是比较在一个大型真实世界的LP患者队列中，按植入时年龄分层的临床适应证、围手术期和中期与设备相关的结局。
从iLEAPER注册研究中检索出两组年轻和老年患者（≤50岁和>50岁）。主要结局是比较两组中为何优先选择LP而非经静脉起搏器的潜在适应证。围手术期和中期随访主要并发症的发生率以及LP的电性能被视为次要结局。
共纳入1154例患者，年轻患者占整个队列的6.2%。感染和血管问题是老年队列中导致植入LP的最常见特征（45.8%对67.7%，p<0.001；4.2%对16.4%，p=0.006），而患者偏好是年轻队列中选择LP的主要原因（47.2%对5.6%，p<0.001）。两组的中位总手术时间（52[40-70]分钟对50[40-65]分钟）和透视时间相似。4.3%的患者发生围手术期并发症，组间无差异。年轻患者出院时和最后随访时的阈值均较高（0.63[0.5-0.9]伏对0.5[0.38-0.7]伏，p=0.004）。
在考虑LP适应证时，患者偏好在年轻患者中更常见，而感染和血管问题在老年队列中更频繁。与设备相关的并发症发生率无显著差异。年轻患者在中期随访时起搏阈值往往略高。
