# Safety of Leadless Pacemaker Insertion in Nonagenarians

## TL;DR

Leadless pacemaker insertion in patients aged 90 and older is generally safe with lower mortality and fewer complications compared to younger patients.

## Contribution

This study provides evidence that age alone is not a risk factor for poor outcomes in leadless pacemaker procedures.

## Key findings

- Nonagenarians had shorter hospital stays and lower mortality after leadless pacemaker insertion.
- They had reduced rates of cardiac arrest, mechanical ventilation, and vasopressor use.
- Nonagenarians faced a higher risk of pericardial complications but not of stroke or readmission.

## Abstract

Increased age is associated with increased frailty and often worse postoperative outcomes. We sought to assess the safety of leadless pacemaker (LPM) insertion in the very elderly population. We queried the National Readmission Database for patients who underwent LPM insertion from 2017 to 2020. Patients aged ≥90 years were included in the nonagenarian group and compared to patients aged <90 years. Patient comorbidities were queried using the appropriate International Classification of Diseases, Tenth Revision, codes. We compared outcomes using multivariate logistic and linear regression, adjusting for patient comorbidities. At baseline, nonagenarians had higher prevalence rates of hypertension, a history of stroke, atrial fibrillation, atrial flutter, dementia, and hypothyroidism. The control group had more diabetes, coronary artery disease, chronic kidney disease, chronic pulmonary disease, oxygen use, coagulopathy, anemia, obesity, substance abuse, and chronic liver disease. Compared to controls, nonagenarians were found to have a shorter length of stay (2.5 days; P < .001); lower mortality (adjusted odds ratio [aOR], 0.7; P = .02); and lower rates of post-procedural cardiac arrest (aOR, 0.3; P = .03), mechanical ventilation (aOR, 0.4; P < .001), and vasopressor use (aOR, 0.6; P = .001). Nonagenarians were only found to have an increased risk of pericardial complications (tamponade, pericardiocentesis, hemopericardium) (aOR, 1.6; P = .02). There was no significant difference in 30-day readmissions (aOR, 0.97; P = .7), postoperative bleed (aOR, 0.84; P = .07), or stroke (aOR, 0.586; P = .1). Our study demonstrates that LPM insertion could be safe in the very elderly population. However, our study likely demonstrates survivorship bias, as patients in the nonagenarian group had fewer overall comorbidities. Despite adjustment for known comorbidities, there remain confounders that are difficult to account for. Age itself does not seem to be a risk factor for worse outcomes in this population.