Background: In patients with symptomatic permanent atrial fibrillation (AF) who are not candidates for rhythm control, atrioventricular node (AVN) ablation followed by ventricular pacing “ablate-and-pace” offers reliable rate control and symptom relief. Conventional transvenous systems are effective but associated with lead- and pocket-related complications. Leadless pacemakers represent a promising alternative, yet comparative data in this setting remain scarce. The aim is to compare clinical outcomes of leadless vs. transvenous single-chamber pacemakers in patients undergoing AVN ablation for permanent AF. Methods: We conducted a retrospective, multicenter study (LEAD-AP) of 168 consecutive patients undergoing ablate-and-pace between 2,017 and 2024 across four European centers. Patients received either a leadless pacemaker (n = 56) or a conventional transvenous VVI pacemaker (n = 112). The primary efficacy endpoint was the composite of all-cause mortality, cardiovascular mortality, AF-related hospitalizations, unplanned visits and device-related hospitalizations or reinterventions. The secondary efficacy endpoint was device-related hospitalizations or reinterventions. The primary safety endpoint was acute complications within 30 days. Results: Patients in the leadless group more frequently underwent a single-step ablate-and-pace strategy (96.4\% vs. 10.9\%, p < 0.001), resulting in shorter hospitalization (1.1 days ± 3.1 vs. 5.7 days ± 2.2, p = 0.008). At 24 months of follow-up, there was no statistically significant difference between patients with leadless pacemaker vs. standard single-chamber VVI pacemaker in the event-free survival for the clinical efficacy endpoint (82.1\% vs. 80.4\% Log-Rank p = 0.29). Conclusions: Leadless pacemakers provide comparable safety and efficacy to transvenous systems in ablate-and-pace patients, while enabling shorter hospitalization through a streamlined single-step approach.
Overeinder, I, Pannone, L, Laviola, D, Zaher, W, Mugnai, G, Arabia, G, Eltsov, I, Doundoulakis, I, Della Rocca, DG, Calburean, PA, Pašara, V, Carmagnola, L, Sattin, T, Sorgente, A, Del Monte, A, Talevi, G, Bala, G, Almorad, A, Ströker, E, Sieira, J, Gharaviri, A, La Meir, M, Brugada, P, Sarkozy, A, Chierchia, GB, Curnis, A, Boveda, S & de Asmundis, C 2026, 'Precision patient selection for ablate-and-pace: a multi-center study comparing leadless pacemaker vs. standard pacemaker in patients with indication to ablate-and-pace for atrial fibrillation (LEAD-AP)', Frontiers in Cardiovascular Medicine, vol. 13, 1741074, pp. 1-10. https://doi.org/10.3389/fcvm.2026.1741074
Overeinder, I., Pannone, L., Laviola, D., Zaher, W., Mugnai, G., Arabia, G., Eltsov, I., Doundoulakis, I., Della Rocca, D. G., Calburean, P. A., Pašara, V., Carmagnola, L., Sattin, T., Sorgente, A., Del Monte, A., Talevi, G., Bala, G., Almorad, A., Ströker, E., ... de Asmundis, C. (2026). Precision patient selection for ablate-and-pace: a multi-center study comparing leadless pacemaker vs. standard pacemaker in patients with indication to ablate-and-pace for atrial fibrillation (LEAD-AP). Frontiers in Cardiovascular Medicine, 13, 1-10. Article 1741074. https://doi.org/10.3389/fcvm.2026.1741074
@article{f14e969253094f1ba1d7e33e15a37a9e,
title = "Precision patient selection for ablate-and-pace: a multi-center study comparing leadless pacemaker vs. standard pacemaker in patients with indication to ablate-and-pace for atrial fibrillation (LEAD-AP)",
abstract = "Background: In patients with symptomatic permanent atrial fibrillation (AF) who are not candidates for rhythm control, atrioventricular node (AVN) ablation followed by ventricular pacing “ablate-and-pace” offers reliable rate control and symptom relief. Conventional transvenous systems are effective but associated with lead- and pocket-related complications. Leadless pacemakers represent a promising alternative, yet comparative data in this setting remain scarce. The aim is to compare clinical outcomes of leadless vs. transvenous single-chamber pacemakers in patients undergoing AVN ablation for permanent AF. Methods: We conducted a retrospective, multicenter study (LEAD-AP) of 168 consecutive patients undergoing ablate-and-pace between 2,017 and 2024 across four European centers. Patients received either a leadless pacemaker (n = 56) or a conventional transvenous VVI pacemaker (n = 112). The primary efficacy endpoint was the composite of all-cause mortality, cardiovascular mortality, AF-related hospitalizations, unplanned visits and device-related hospitalizations or reinterventions. The secondary efficacy endpoint was device-related hospitalizations or reinterventions. The primary safety endpoint was acute complications within 30 days. Results: Patients in the leadless group more frequently underwent a single-step ablate-and-pace strategy (96.4\% vs. 10.9\%, p < 0.001), resulting in shorter hospitalization (1.1 days ± 3.1 vs. 5.7 days ± 2.2, p = 0.008). At 24 months of follow-up, there was no statistically significant difference between patients with leadless pacemaker vs. standard single-chamber VVI pacemaker in the event-free survival for the clinical efficacy endpoint (82.1\% vs. 80.4\% Log-Rank p = 0.29). Conclusions: Leadless pacemakers provide comparable safety and efficacy to transvenous systems in ablate-and-pace patients, while enabling shorter hospitalization through a streamlined single-step approach.",
keywords = "ablate-and-pace, atrial fibrillation, atrioventricular node ablation, leadless pacemaker, transvenous pacemaker",
author = "Ingrid Overeinder and Luigi Pannone and Domenico Laviola and Wael Zaher and Giacomo Mugnai and Gianmarco Arabia and Ivan Eltsov and Ioannis Doundoulakis and \{Della Rocca\}, \{Domenico Giovanni\} and Calburean, \{Paul Adrian\} and Vedran Pa{\v s}ara and Ludovica Carmagnola and Tommaso Sattin and Antonio Sorgente and \{Del Monte\}, Alvise and Giacomo Talevi and Gezim Bala and Alexandre Almorad and Erwin Str{\"o}ker and Juan Sieira and Ali Gharaviri and \{La Meir\}, Mark and Pedro Brugada and Andrea Sarkozy and Chierchia, \{Gian Battista\} and Antonio Curnis and Serge Boveda and \{de Asmundis\}, Carlo",
note = "Publisher Copyright: 2026 Overeinder, Pannone, Laviola, Zaher, Mugnai, Arabia, Eltsov, Doundoulakis, Della Rocca, Calburean, Pasara, Carmagnola, Sattin, Sorgente, Del Monte, Talevi, Bala, Almorad, Str{\"o}ker, Sieira, Gharaviri, La Meir, Brugada, Sarkozy, Chierchia, Curnis, Boveda and de Asmundis.",
year = "2026",
doi = "10.3389/fcvm.2026.1741074",
language = "English",
volume = "13",
pages = "1--10",
journal = "Frontiers in Cardiovascular Medicine",
issn = "2297-055X",
publisher = "Frontiers Media",
}