Leadless pacemaker in patients with chronic kidney disease and hemodialysis

a scoping review

Abstract

Introduction: Chronic kidney disease (CKD) is a global health condition affecting approximately 10% of the adult population and is associated with high morbidity and mortality. Patients with CKD are at an increased risk of developing cardiovascular diseases and arrhythmias, often requiring pacemaker implantation. The leadless pacemaker has been studied in various populations and offers advantages over traditional devices. However, the efficacy and safety of using leadless pacemakers in this population remain uncertain. Objective: This study aims to map the existing literature on the use of leadless pacemakers in patients with chronic kidney disease (CKD) undergoing hemodialysis, addressing aspects of efficacy, safety, and factors related to their adoption in clinical practice. Methodology: A scoping review was conducted following the PRISMA protocol. Searches were performed in the PubMed, Embase, Scopus, Cochrane Library, and CINAHL databases, covering studies that addressed leadless pacemakers, chronic kidney disease, and hemodialysis. Articles in English, Portuguese, and Spanish were included, with no time restrictions. Results: A total of 230 articles were found during the initial search. After the exclusion of duplicates, 165 studies remained and were analyzed based on their titles and abstracts. After the analysis, 25 articles were considered eligible for full-text reading and the application of eligibility criteria. After reading, 15 studies were included in this review. The types of studies found were: 7 (46.6%) case reports, 6 (40%) observational studies, 1 (6.6%) editorial comment, and 1 (6.6%) review article. Among the studies, 7 (46.6%) concluded that the leadless pacemaker is associated with improved clinical outcomes when compared to the transvenous pacemaker in patients with chronic kidney disease and undergoing hemodialysis due to the failure of vascular accesses and the higher risk of infection in this population. One (6.6%) study demonstrated an association between the leadless pacemaker and a higher rate of perioperative and early post-implantation complications when compared to the conventional pacemaker. Conclusion: The results of this scoping review suggest that the leadless pacemaker is an effective alternative with a higher safety profile in the medium and long term compared to conventional devices in patients with chronic kidney disease and undergoing hemodialysis. However, the literature remains conflicting regarding safety during the perioperative and early post-implantation periods, and further studies are needed for a better understanding of the topic.