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

Backgrounds: 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. Methods: 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. Results: 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. Conclusions: 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.