Safety of leadless versus transvenous pacemakers in patients with low body surface area: a matched-pair analysis
1
Issued Date
2026-12-01
Resource Type
eISSN
14712261
Scopus ID
2-s2.0-105029698020
Pubmed ID
41545909
Journal Title
BMC Cardiovascular Disorders
Volume
26
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Cardiovascular Disorders Vol.26 No.1 (2026)
Suggested Citation
Apiyasawat S., Soontornmanokati N., Ngarmukos T., Methachittiphan N. Safety of leadless versus transvenous pacemakers in patients with low body surface area: a matched-pair analysis. BMC Cardiovascular Disorders Vol.26 No.1 (2026). doi:10.1186/s12872-026-05526-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115093
Title
Safety of leadless versus transvenous pacemakers in patients with low body surface area: a matched-pair analysis
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Abstract
Background: Leadless pacemakers (LPs) avoid lead- and pocket-related issues but require large venous access, which raises safety concerns in patients with a small body surface area (BSA), particularly in Asian populations. We defined low BSA as < 1.46 m², based on validated 3D-derived anthropometric standards for Chinese adults. Objective: To assess procedural complication rates of LP implantation in patients with low BSA. Methods: We analyzed LP implantations from 2016 to 2025 at a single center in Thailand. Of 59 patients, 25 (42.4%) had low BSA. We conducted two comparisons: (1) low- vs. normal/high-BSA LP patients and (2) low-BSA LP patients with a 1:2 age-, sex-, and BSA-matched transvenous pacemaker (TVP) cohort. The primary outcome was major device-related complications. Results: LP patients were elderly (median 79 years) with high comorbidity (median Charlson Comorbidity Index [CCI], 7.0). In the matched analysis, low-BSA LP patients had a significantly higher comorbidity burden than TVP controls (median CCI, 7.0 vs. 5.0; P = 0.002). The 3.8-year cumulative incidence of major complications did not differ between low- vs. normal/high-BSA LP patients (8.0% vs. 8.8%, P = 0.39) and between low-BSA LP patients vs. matched TVP controls (8.0% vs. 14.0%, P = 0.91). Adjusted analyses revealed no significant association between device type and complications, although the confidence intervals were wide. Conclusion: In this exploratory analysis, patients with low-BSA showed no increased risk of major complications following LP implantation. However, given the small sample size and pronounced selection bias, these findings should be interpreted with caution.