# Leadless pacemaker implantation in real‐world clinical practice: An Italian survey promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

## TL;DR

An Italian survey shows that leadless pacemakers are used in specific cases due to cost and technical barriers, with potential for wider adoption as costs decrease.

## Contribution

This survey provides real-world insights into the clinical adoption and perception of leadless pacemakers among Italian electrophysiologists.

## Key findings

- Leadless pacemakers are mainly chosen for patients with anatomic contraindications or high infection risk.
- Cost is the main barrier to wider adoption of leadless pacemakers.
- Implantation is feasible with local anesthesia and short procedure times.

## Abstract

After a decade since the introduction of leadless pacemaker (L‐PM), its use is still limited. The aim of this survey is to evaluate how this technology is perceived by electrophysiologist members of a National scientific society in clinical practice.

A questionnaire with 22 questions was posted in the reserved area of the society website. The multiple‐choice questions concerned the center's characteristics, patient selection criteria, limitations to the L‐PM use, implant procedures, and follow‐up. Additionally, non‐implanting centers were also allowed to participate by completing the initial nine questions.

Ninety‐two responders participated in this survey: 59% implanted <20 L‐PM yearly and 31% did not implant L‐PM. The three main reasons to choose an L‐PM were anatomic contraindications to a transvenous pacemaker, the patient's high infective risk, and previous lead extraction, accounting for 78%, 74%, and 64% of the responses, respectively. Age >60 years was indicated as more suitable by most of the responders. Among the implanting centers, the main limitation to a wider adoption was cost (49%), the lack of atrial pacing (28%), the absence of a dedicated extraction tool, and data on replacement (22%). The L‐PM implant was performed with only local anesthesia in 77% of the centers and was associated with limited procedure duration and fluoroscopy time even in low‐volume centers.

Although the L‐PM implant is not a particularly complex procedure, these data confirm that its use is currently limited to selected patients of older age. Cost decreases and new developments might increase the adoption of this technology.

A survey of Italian electrophysiologists identified key reasons for choosing L‐PM: anatomic contraindications, high infection risk, and prior lead extraction. Barriers include cost, lack of atrial pacing, and extraction tools. The use of L‐PM implantation is currently limited to selected patients of older age. Wider adoption may follow cost reduction and technological advances.