Conventional transvenous pacemakers are the first-line treatment for slow heart rhythms, but they cause significant complications in around one in ten patients. Leadless pacemakers were developed to avoid many of those problems. In the UK, though, guidance restricts their use to research or to patients for whom conventional pacing is unsuitable, so they remain a relatively niche procedure, and there is no head-to-head trial against transvenous devices to draw on.
To capture where UK implanting experts agree, a panel developed 36 statements across five topics. The statements were tested through a modified Delphi consensus, with a survey sent to UK leadless implanters and completed by 27 of them. Consensus was pre-specified at 66% agreement, with very high agreement set at 90%.
Thirty-one of the 36 statements reached consensus, 23 of them at very high agreement. The seven recommendations call for better education for implanters and referrers, a national registry to track complications and risks, and a defined pathway for timely cardiac surgical support. Shared decision-making with patients drew unanimous agreement.
Triducive managed and facilitated this modified Delphi consensus on behalf of the authors, analysing the data and supporting the manuscript. Acting on the recommendations could help more patients benefit from leadless pacing within a safer, better-defined pathway.
Roberts P, et al. Arrhythmia & Electrophysiology Review, 2022; 11: e19. DOI: 10.15420/aer.2022.17
