Nationwide Lifespan Trends in Cardiac Implantable Electronic Device Strategies in Japan: Age‐Dependent Changes in Transvenous and Epicardial Systems

ABSTRACT Background Nationwide epidemiological studies of cardiac implantable electronic devices (CIEDs) encompassing multiple device types and strategies remain limited in Japan, particularly regarding epicardial lead use and pediatric populations. Methods We performed the first nationwide analysis of CIED implantation trends using the National Database of Health Insurance Claims, including transvenous (TV)/epicardial (Epi) systems for pacemakers, implantable cardioverter‐defibrillators (ICDs), cardiac resynchronization therapy (CRT), and CRT‐defibrillators (CRTDs), as well as leadless pacemakers, subcutaneous ICDs (S‐ICDs), and epicardial lead use. Epicardial lead and pediatric characteristics were supplemented using industry data. Results In fiscal year 2023, implantation rates per 100 000 population were 29.69 for TV‐pacemakers, 7.06 for leadless pacemakers, 2.42 for TV‐ICDs, 0.889 for S‐ICDs, 1.20 for TV‐CRT, and 1.69 for TV‐CRTDs. Rates for epicardial systems were lower, at 0.173 for Epi‐pacemakers, 0–0.007 for Epi‐ICDs, 0.024 for Epi‐CRT, and 0.027 for Epi‐CRTDs, while epicardial lead use was 0.545. S‐ICD use increased across age groups, whereas TV‐ICD implantation declined (all p < 0.001). Implantation of TV and leadless pacemakers, TV‐CRT, and TV‐CRTDs increased over time (all p < 0.001). Epicardial lead use showed a bimodal age distribution, peaking in pediatric and elderly populations, and declined in older adults while remaining stable in children and adults aged 20–49 years ( p < 0.001). Pediatric CIED volumes were low, with several ICD, CRT, and CRTD procedures annually. Conclusions CIED strategies in Japan demonstrate age‐dependent variation. Epicardial systems remain indispensable in pediatric and congenital heart disease care, whereas alternative technologies are increasingly adopted in older adult populations, reflecting evolving lifespan‐related device strategies.