Retrospective evaluation of the predictive value of acute pacing capture threshold for long-term outcomes in Chinese patients with leadless pacemakers

The leadless pacemaker represents a significant advancement in cardiac pacing technology. This retrospective, single-center cohort study aims to evaluate whether acute impedance and pacing thresholds can predict long-term pacing capture threshold (PCT) in Chinese patients implanted with leadless pacemakers. A total of 409 Chinese patients who underwent Micra leadless pacemaker implantation between January 2019, and November 2023, were included in the study.Among them, 19 patients were classified as having very high PCT levels due to elevated levels persisting from implantation to the final follow-up. Receiver operating characteristic (ROC) curve analysis revealed that acute PCT is a significant predictor of long-term PCT elevation, with an area under the curve (AUC) of 0.733, a sensitivity of 77.8%, and a specificity of 61.1%.Similarly, acute pacing impedance was found to significantly predict long-term PCT elevation, with an AUC of 0.689, a sensitivity of 83.3%, and a specificity of 50.9%. Furthermore, multivariate Cox proportional hazards regression analysis identified acute PCT ≥ 1.0 V (HR = 3.62, 95% CI = 1.19-11.00, p < 0.05) as an independent predictor of long-term PCT elevation. Additionally, acute pacing impedance < 800 Ω (HR = 3.76, 95% CI = 1.17-12.10, p < 0.05) was found to independently predict long-term PCT elevation. These findings underscore the importance of monitoring acute parameters during implantation to ensure optimal long-term device performance and reliability.