B-po03-036 impact of leadless pacemaker implantation during valve surgery on length of stay

The leadless cardiac pacemaker (LCP) is typically implanted percutaneously, but can also be implanted under direct visualization during valve surgery in patients with either a pre-existing pacing indication or who are at high risk for post-op bradyarrhythmias. To compare the impact of timing of LCP implantation on the length of hospitalization in patients undergoing intra-operative (during valve surgery) vs post-operative (prior to discharge) leadless pacemaker implantation. We conducted a retrospective review of patients undergoing valve surgery between 8/1/2018 and 11/30/2020, and received an LCP (Micra, Medtronic Inc) either intra-operatively (n=27) or post-operatively (n=23) during the index hospitalization. The STS short-term risk scores for mortality and/or morbidity were similar between the intra-operative and post-operative groups (1.6 vs 2.3%, p = 0.646; 14.6 vs 12.7%, p = 0.437, respectively). Patients receiving an intra-operative LCP spent significantly fewer median days in the ICU (3 vs 5 days, p = 0.03) and had a significantly shorter median total length of stay (11 vs 16 days, p = 0.036). Despite similar pre-operative co-morbidities, intra-operative implantation of an LCP in select patients at high risk for post-operative bradyarrhythmias is associated with a significantly shorter lengths of stay in both the ICU and the hospital. Future studies should identify which patients may benefit most from this prophylactic approach to pacing in at-risk patients undergoing valve surgery.