Real-World Outcomes of Leadless Pacemaker Implantation After Transvenous Lead Removal for Infected Cardiac Implantable Electronic Devices in the United States.

Leadless pacemakers (LPMs) have emerged as a promising alternative to transvenous systems, particularly in patients requiring transvenous lead removal (TLR) due to cardiac implantable electronic device (CIED) infections. However, real-world outcomes following LPM implantation in this setting remain understudied. Using the National Readmissions Database from 2016 to 2021, we identified 41,058 adult patients who underwent LPM implantation, of whom 3,244 (7.9%) received the device following TLR for CIED infection. Compared to patients undergoing de novo implantation, those in the post-TLR cohort were younger, had a greater comorbidity burden, and experienced significantly higher rates of device-related complications (3.7% vs. 2.0%; adjusted odds ratio [aOR]: 1.64; 95% confidence interval [CI]: 1.22-2.20; p<0.01), longer hospital stays, and lower rates of discharge to home. Despite these differences, there were no significant disparities in in-hospital mortality (4.5% vs. 4.8%, p=0.59) or 30-day and 180-day readmission rates, including for device-related complications or infective endocarditis. These findings suggest that while LPM implantation following TLR is associated with higher procedural complexity, it remains a viable and safe option in this high-risk population and provides important real-world context to guide clinical decision-making.