LAUSR

BACKGROUND Single-chamber leadless intracardiac pacemaker (LICP) implantation was approved in 2016 in the United States. However, little is known regarding trends in real-world utilization and complication rates. OBJECTIVE We sought to assess nationwide demographics, trends, and outcomes among hospitalizations with LICP implantation in the United States. METHODS Using the National Inpatient Sample, we identified all hospitalizations with LICP or transvenous pacemaker implantation as a comparator between 2017-2019. We evaluated baseline patient characteristics, admitting diagnoses, procedural complications, length of stay, discharge disposition and all-cause mortality. RESULTS The majority of LICP recipients were elderly (75.4 ± 12.8 years), male (55.2%) and White (76.8%) compared to Black (9.8%), or Hispanic (7.3%). Between 2017-2019, the average age increased along with the prevalence of heart failure, atrial fibrillation, and malignancy among recipients. Most hospitalizations were emergent (84.5%). Between 2017-2019, pooled procedural complications decreased significantly (10.8% vs. 7.9%, p < 0.001), primarily due to declining infection and device retrieval rates. In-hospital mortality also decreased significantly (8.2% vs. 4.2%, p < 0.001). History of cardiogenic shock or cardiac device infection were associated with greatest mortality or complication risk. Compared to transvenous pacemaker, LICP implantation was associated with lower complication rates (8.6% vs. 11.2%) but greater mortality (5.2% vs. 1.3%, p < 0.001). CONCLUSION Nationwide LICP implantations were performed in patients of increasing age, comorbidities, and acuity of illness. In-hospital mortality and procedure-related complications declined in the first three years following approval and may reflect improving operator experience. Increased mortality compared with transvenous pacemaker implant remains a concern.