# Precision patient selection for ablate-and-pace: a multi-center study comparing leadless pacemaker vs. standard pacemaker in patients with indication to ablate-and-pace for atrial fibrillation (LEAD-AP)

## TL;DR

This study compares leadless and standard pacemakers in patients with atrial fibrillation undergoing ablate-and-pace procedures, finding similar safety and efficacy but shorter hospital stays with leadless devices.

## Contribution

Demonstrates that leadless pacemakers offer comparable clinical outcomes to standard pacemakers in ablate-and-pace procedures, with reduced hospitalization duration.

## Key findings

- Leadless pacemaker patients had shorter hospital stays compared to those with standard pacemakers.
- There was no significant difference in event-free survival between the two groups at 24 months.
- Leadless pacemakers enabled a single-step ablate-and-pace strategy more frequently.

## Abstract

In patients with symptomatic permanent atrial fibrillation (AF) who are not candidates for rhythm control, atrioventricular node (AVN) ablation followed by ventricular pacing “ablate-and-pace” offers reliable rate control and symptom relief. Conventional transvenous systems are effective but associated with lead- and pocket-related complications. Leadless pacemakers represent a promising alternative, yet comparative data in this setting remain scarce. The aim is to compare clinical outcomes of leadless vs. transvenous single-chamber pacemakers in patients undergoing AVN ablation for permanent AF.

We conducted a retrospective, multicenter study (LEAD-AP) of 168 consecutive patients undergoing ablate-and-pace between 2,017 and 2024 across four European centers. Patients received either a leadless pacemaker (n = 56) or a conventional transvenous VVI pacemaker (n = 112). The primary efficacy endpoint was the composite of all-cause mortality, cardiovascular mortality, AF-related hospitalizations, unplanned visits and device-related hospitalizations or reinterventions. The secondary efficacy endpoint was device-related hospitalizations or reinterventions. The primary safety endpoint was acute complications within 30 days.

Patients in the leadless group more frequently underwent a single-step ablate-and-pace strategy (96.4% vs. 10.9%, p < 0.001), resulting in shorter hospitalization (1.1 days ± 3.1 vs. 5.7 days ± 2.2, p = 0.008). At 24 months of follow-up, there was no statistically significant difference between patients with leadless pacemaker vs. standard single-chamber VVI pacemaker in the event-free survival for the clinical efficacy endpoint (82.1% vs. 80.4% Log-Rank p = 0.29).

Leadless pacemakers provide comparable safety and efficacy to transvenous systems in ablate-and-pace patients, while enabling shorter hospitalization through a streamlined single-step approach.

Infographic comparing leadless and standard VVI pacemakers in the LEAD-AP study across four European centers with 168 patients, presenting demographics, procedural outcomes, hospitalization duration, acute complications, and Kaplan-Meyer curves of event-free survival at twelve and twenty-four months.