ArticleJournal of the American Heart Association2026
Comparison of Outcomes of Leadless Versus Transvenous Pacemakers Following Tricuspid Valve Surgery.
Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
backgroundTransvenous pacemaker implantation after tricuspid valve surgery may cause adverse outcomes due to lead-valve interactions. Although leadless pacemakers may mitigate these risks, empirical data remain limited.
methodsWe compared outcomes of leadless versus transvenous pacemakers following tricuspid surgery using a target trial emulation framework. We analyzed Medicare beneficiaries aged ≥65 years who underwent tricuspid valve surgery and received a pacemaker during the index admission between 2017 and 2021, using propensity score matching weight analysis to control for confounders. Primary outcomes were in-hospital death and 2-year heart failure hospitalization. Secondary outcomes included 2-year death.
resultsWe included 185 and 1336 patients in the leadless and transvenous groups, respectively. Use of leadless pacemakers increased from 6.3% in 2017 to 17.5% in 2021. Leadless pacemaker recipients more often underwent tricuspid valve replacement (29.2% versus 8.5%) while concomitant mitral surgery was less common (69.2% versus 86.8%). After adjustment, we found no evidence that in-hospital death (adjusted odds ratio, 1.82 [95% CI, 0.65-5.13] for leadless) and 2-year heart failure hospitalizations (subdistribution hazard ratio [HR], 0.88 [95% CI, 0.60-1.30] for leadless) differed between the 2 groups. We also found no evidence that 2-year death (adjusted HR, 1.04 [95% CI, 0.69-1.57] for leadless) differed between groups.
conclusionsNo statistically significant differences were detected between leadless versus transvenous pacemaker implantations after tricuspid valve surgery. However, CIs were wide, and a clinically meaningful difference in either direction cannot be excluded. The study may therefore be underpowered, and the absence of echocardiographic data limits assessment of tricuspid regurgitation, warranting prospective studies.
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