Pericardial effusion requiring intervention in patients undergoing leadless pacemaker implantation: A real-world analysis from the National Inpatient Sample database

Background

Pericardial effusion requiring percutaneous or surgical-based intervention remains an important complication of a leadless pacemaker implantation.

Objective

The study sought to determine real-world prevalence, risk factors, and associated outcomes of pericardial effusion requiring intervention in leadless pacemaker implantations.

Methods

The National Inpatient Sample and International Classification of Diseases–Tenth Revision codes were used to identify patients who underwent leadless pacemaker implantations during the years 2016 to 2020. The outcomes assessed in our study included prevalence of pericardial effusion requiring intervention, other procedural complications, and in-hospital outcomes. Predictors of pericardial effusion were also analyzed.

Results

Pericardial effusion requiring intervention occurred in a total of 325 (1.1%) leadless pacemaker implantations. Patient-level characteristics that predicted development of a serious pericardial effusion included >75 years of age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08–1.75), female sex (OR 2.03, 95% CI 1.62–2.55), coagulopathy (OR 1.50, 95% CI 1.12–1.99), chronic pulmonary disease (OR 1.36, 95% CI 1.07–1.74), chronic kidney disease (OR 1.53, 95% CI 1.22–1.94), and connective tissue disorders (OR 2.98, 95% CI 2.02–4.39). Pericardial effusion requiring intervention was independently associated with mortality (OR 5.66, 95% CI 4.24–7.56), prolonged length of stay (OR 1.36, 95% CI 1.07–1.73), and increased cost of hospitalization (OR 2.49, 95% CI 1.92–3.21) after leadless pacemaker implantation.

Conclusion

In a large, contemporary, real-world cohort of leadless pacemaker implantations in the United States, the prevalence of pericardial effusion requiring intervention was 1.1%. Certain important patient-level characteristics predicted development of a significant pericardial effusion, and such effusions were associated with adverse outcomes after leadless pacemaker implantations.