Abstract 4141344: Leadless Pacemaker vs. Transvenous Pacemaker in End Stage Kidney Disease: Insights from the Nationwide Readmission Database

Background: Leadless pacemakers offer a safe and effective alternative pacing strategy, crucial for patients with end-stage renal disease (ESRD) overcoming vascular access isues. However, there is limited data available on their use in this population. Methods: We utilized the Nationwide Readmission Database to extract data on all adult patients with ESRD who received either traditional transvenous or leadless pacemaker implantation from 2016 to 2021. We then compared in-hospital mortality, in-hospital complications, healthcare resource utilization, and 30-day readmission rates between these two groups. Results: A total of 6,384 patients (81.2%) were included in the transvenous pacemaker cohort, while 1,481 patients (18.8%) were in the leadless pacemaker cohort. In ESRD patients, leadless pacemaker implantation was associated with higher in-hospital complications compared to transvenous pacemakers, including cardiac complications (aOR 4.12, CI 1.70-9.98, p<0.01), vascular complications (aOR 3.6, CI 1.40-9.26, p=0.01), and the need for blood transfusions (aOR 1.85, CI 1.32-2.60, p<0.01). There was no difference between the cohorts in terms of in-hospital mortality and 30-day readmission rates. However, the median length of stay was longer for leadless pacemaker implantation (5 days vs. 4 days, p<0.01), and the total hospitalization charges were higher ($139,826 vs. $93,919, p<0.01). Conclusion: In conclusion, while LPM implantation in ESRD patients was associated with higher in-hospital complications and healthcare resource utilization compared to TVPM, there was no significant difference in in-hospital mortality and 30-day readmission rates. Further research is needed to understand the nature of these complications and optimize outcomes for ESRD patients undergoing LPM implantation.