{
  "abstract": "Introduction The introduction and growing use of leadless pacemakers have provided physicians with a safer alternative to traditional transvenous systems, particularly for high-risk populations. Patients with prior cerebrovascular disease (pCVD) face increased perioperative risks during cardiac procedures, yet outcomes data for leadless pacemaker implantation in this vulnerable cohort remain limited, especially in non-elective settings.Methods We identified non-elective leadless pacemaker implantations from 2016-2023 using the National Inpatient Sample, excluding patients with concurrent device implantations or preexisting pacemakers. Patients were stratified by pCVD. Multivariable regression analyses estimated adjusted odds ratios (aOR) for adverse events, adjusting for confounders with p<0.20 in univariable analyses.Results An estimated 11.2% (5,520) of the 49,520 non-elective leadless pacemaker implantations occurred in patients with pCVD. Patients with pCVD were older (mean age:80.1 vs 76.9 years, p<0.001), more likely to be female (48.1% vs 44.0%, male 51.9% vs 56.0%, p=0.010), and had higher prevalence of hypertension (91.8% vs 85.8%), dyslipidemia (69.8% vs 57.2%), prior myocardial infarction (11.5% vs 8.2%), valvular disease (33.0% vs 28.8%), smoking (38.0% vs 31.5%), prior percutaneous coronary intervention (12.5% vs 8.9%), prior coronary artery bypass grafting (11.3% vs 7.9%), and anticoagulation use (43.6% vs 28.5%) (p<0.05 throughout). pCVD patients were less likely to have obesity (14.6% vs 19.3%, p<0.001) and cirrhosis (2.6% vs 4.5%, p=0.005). No significant differences were observed in congestive heart failure (49.1% vs 50.9%, p=0.208), chronic kidney disease (38.4% vs 39.7%, p=0.429), chronic obstructive pulmonary disease (19.6% vs 18.9%, p=0.592), or mean Charlson Comorbidity Index (3.10 vs 3.14, p=0.620). Multivariable regression models demonstrated that pCVD patients had significantly lower odds of device infection (aOR 0.70, 95% CI 0.51-0.98, p=0.038), cardiac arrest (aOR 0.65, 95% CI 0.44-0.95, p=0.028), acute kidney injury(AKI)(aOR 0.79, 95% CI 0.68-0.92, p=0.002), and AKI requiring hemodialysis(AKI-HD)(aOR 0.48, 95% CI 0.20-0.91, p=0.020). No significant differences were observed in mortality (aOR 0.76, p=0.223), cardiac tamponade (aOR 0.87, p=0.722), major bleeding (aOR 1.03, p=0.893), myocardial infarction (aOR 0.96, p=0.729), ischemic stroke (aOR 1.29, p=0.183), or hemorrhagic stroke (aOR 0.74, p=0.604).Conclusion Despite higher baseline comorbidity burden, pCVD patients demonstrated comparable mortality and lower rates of device infection, cardiac arrest, AKI, and AKI-HD. These findings may reflect enhanced perioperative risk assessment and clinical monitoring in this high-risk population.",
  "authors": [
    {
      "affiliations": [
        "Cleveland clinic Akron General, Akron, United States"
      ],
      "name": "Sakshi Dixit"
    },
    {
      "affiliations": [
        "James Cook University Hospital, Middlesbrough, United Kingdom"
      ],
      "name": "Mohamed Abdelrahman"
    },
    {
      "affiliations": [
        "Alexandra Hospital, Redditch, United Kingdom"
      ],
      "name": "Mohsin Nawaz"
    },
    {
      "affiliations": [
        "Cleveland clinic Akron General, Akron, United States"
      ],
      "name": "FNU Anamika"
    },
    {
      "affiliations": [
        "Trinity Livonia, Michigan, United States"
      ],
      "name": "Juma Rashid Bin Firos"
    },
    {
      "affiliations": [
        "Independent Researcher, Triolet, Mauritius"
      ],
      "name": "Kamleshun Ramphul"
    },
    {
      "affiliations": [
        "Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom"
      ],
      "name": "Raheel Ahmed"
    }
  ],
  "title": "455 Outcomes of non-elective leadless pacemaker implantation in patients with prior cerebrovascular disease: a national inpatient sample analysis, 2016-2023",
  "uid": "c8906acb-be9e-58f0-aded-9fdd11876d06"
}