Leadless pacing: First experience and outcomes in an isolated area in the setting of the Greek financial crisis.

BACKGROUND: Leadless pacing (LP) is a novel permanent pacing modality without transvenous leads that is increasingly applied in certain circumstances. We aimed to report our preliminary experience in LP implementation. CASE SERIES: This observational study represents a simple registry of LP systems implanted in our tertiary center from April 2018 until November 2019 in the setting of the Greek financial crisis. Consecutive patients from the isolated area of Northwestern Greece referred to our center for LP were included. Patients' clinical and procedural data, as well as follow-up events, were carefully recorded. Nine patients (mean age: 75 years; six men) were included and were followed for a median period of 20 months. The commonest indication for LP implantation was increased patient infection risk (n: seven), while in the remaining patients (n: two), the indication was problematic vein access along with concomitant comorbidities that increase infection risk. Most of the patients (6/9) were in sinus rhythm, while the rest had slow atrial fibrillation. During the follow-up period, two patients with end-stage renal disease suffered sudden cardiac death, two patients died due to pneumonia, and one patient died due to metastatic cancer. However, no device-related death occurred during the follow-up.
CONCLUSIONS: Our data indicate that LP's long-term cost-effectiveness is limited in patients with several comorbidities due to increased mortality. Indeed, considering its increased financial cost, well-defined patients' selection criteria should be developed and applied, especially in medium/low-income countries. HIPPOKRATIA 2021, 25 (2):75-78. Copyright 2021, Hippokratio General Hospital of Thessaloniki.