INTRODUCTION
Critically ill patients may present a permanent, or at least prolonged, indication of cardiac pacing, either because they are hospitalized following severe bradycardia, or because they incidentally develop repetitive or persistent bradycardia episodes in addition to a primary severe medical condition [1]. These patients may initially require transvenous temporary pacing (TTP), and if bradycardia persists, eventually the implantation of a permanent cardiac pacemaker (PPM). Conventional transvenous PPM implantation can be challenging in patients with multiple central venous lines. It is also associated with an increased risk of severe complications, such as pneumo/haemothorax, haematoma, cardiac injury, lead dislodgement, and of course infection (local pocket and/or lead endocarditis) which often drives the prognosis in this population [2].
Leadless pacemakers (LPMs) have recently emerged as a useful tool in patients requiring a permanent single-chamber pacing device [3,4]. They have been shown to be associated with a low rate of complications, especially a virtually zero risk of infection, even in patients with a previous device infection [5,6]. Moreover, as their implantation is performed through a transvenous femoral approach, they are first-choice devices in patients with unsuitable supracaval venous access.
We sought to evaluate the safety and efficacy of LPM implantation in the high-risk population of patients hospitalized in intensive care unit (ICU) who require prolonged cardiac pacing.