{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:08:19Z","timestamp":1787504899463,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Transvenous pacemakers are effective but carry significant short\u2010 and long\u2010term complications. Leadless pacemakers were developed to overcome these limitations, however, data in high\u2010risk patients ineligible for transvenous systems remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the real\u2010world outcomes of leadless pacemaker in high risk bradyarrhythmia patients unsuitable for transvenous pacing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective, observational, multi center registry (MLPI) across four Israeli hospitals, included all patients undergoing leadless pacemaker implantation July 2021\u2010December 2022 within a national pilot program. Indications included venous abnormalities, prior device infection, Twiddler's syndrome or high infection risk. Procedural success, complications, electrical performance, and mortality were assessed at 48 h, 30 days, and 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 138 patients were enrolled, with a high comorbidity burden (hypertension 74%, heart failure 44%, chronic kidney disease 36%). High grade atrioventricular block was the main pacing indication (70%), and the leading reason for leadless implantation (54%) was high infection risk. Implantation was successful in 98% of the patients, almost all with Micra. Acute complications occurred in 2.9%, (primarily pericardial effusion); three patients (2.2%) died within 48 h. At 1\u2010year, electrical performance remained stable, with low pacing thresholds (median 0.5\u00a0V), preserved sensing, and declining impedance. Two late complications occurred (tamponade, loss of capture). The 1\u2010year cumulative complication rate was 4.7%, and all\u2010cause mortality 12.3%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Leadless pacemaker implantation in a very high\u2010risk Israeli cohort achieved high procedural success, stable performance, and low complication rate, supporting its role as a safe and effective alternative to conventional pacing systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70333","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:50:56Z","timestamp":1782985856000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Leadless Pacemaker Implantation in High\u2010Risk Patients: Real\u2010World Outcomes From a Multicenter Israeli Registry"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0327-3026","authenticated-orcid":false,"given":"Moshe","family":"Katz","sequence":"first","affiliation":[{"name":"Gray School of Medicine Tel Aviv University  Tel Aviv Israel"},{"name":"Davidai Arrhythmia Center Sheba Medical Center  Tel\u2010Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Vander","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The Hebrew University  Jerusalem Israel"},{"name":"Department of Cardiology Hadassah Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Luria","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The Hebrew University  Jerusalem Israel"},{"name":"Department of Cardiology Hadassah Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moshe Rav","family":"Acha","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The Hebrew University  Jerusalem Israel"},{"name":"Jesselson Integrated Heart Center Shaare Zedek Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5665-3735","authenticated-orcid":false,"given":"Yoav","family":"Michowitz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The Hebrew University  Jerusalem Israel"},{"name":"Jesselson Integrated Heart Center Shaare Zedek Medical Center  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alon","family":"Barsheshet","sequence":"additional","affiliation":[{"name":"Gray School of Medicine Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Cardiology Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2452-9510","authenticated-orcid":false,"given":"Gregory","family":"Golovchiner","sequence":"additional","affiliation":[{"name":"Gray School of Medicine Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Cardiology Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Beinart","sequence":"additional","affiliation":[{"name":"Gray School of Medicine Tel Aviv University  Tel Aviv Israel"},{"name":"Davidai Arrhythmia Center Sheba Medical Center  Tel\u2010Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"issue":"4","key":"e_1_2_9_2_1","first-page":"249","article-title":"Leadless Pacemakers: A Contemporary Review","volume":"15","author":"Bhatia N.","year":"2018","journal-title":"Journal of Geriatric Cardiology"},{"issue":"8","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/j.1540-8159.2011.03150.x","article-title":"The 11th World Survey of Cardiac Pacing and Implantable Cardioverter\u2010Defibrillators: Calendar Year 2009\u2013a World Society of Arrhythmia's Project","volume":"34","author":"Mond H. G.","year":"2011","journal-title":"Pacing and Clinical Electrophysiology"},{"issue":"11","key":"e_1_2_9_4_1","first-page":"1296","article-title":"Complications and Health Care Costs Associated With Transvenous Cardiac Pacemakers in a Nationwide Assessment","volume":"3","author":"Cantillon D. J.","year":"2017","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"5","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.hrthm.2011.12.014","article-title":"Incidence and Predictors of Short\u2010 and Long\u2010Term Complications in Pacemaker Therapy: The FOLLOWPACE Study","volume":"9","author":"Udo E. O.","year":"2012","journal-title":"Heart Rhythm"},{"issue":"4","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","DOI":"10.1093\/ehjopen\/oead064","article-title":"Cardiac Device\u2010Related Infective Endocarditis Need for Lead Extraction Whatever the Device According to the ESC EORP EURO\u2010ENDO Registry","volume":"3","author":"Donal E.","year":"2023","journal-title":"European Heart Journal Open"},{"issue":"1","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jacep.2021.11.002","article-title":"Primary Results on Safety and Efficacy From the LEADLESS II\u2010Phase 2 Worldwide Clinical Trial","volume":"8","author":"Reddy V. Y.","year":"2022","journal-title":"JACC Clinical Electrophysiology"},{"issue":"12","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1093\/eurheartj\/ehab767","article-title":"Leadless vs. Transvenous Single\u2010Chamber Ventricular Pacing in the Micra CED Study: 2\u2010Year Follow\u2010up","volume":"43","author":"El\u2010Chami M. F.","year":"2022","journal-title":"European Heart Journal"},{"issue":"10","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1001\/jamacardio.2021.2621","article-title":"Contemporaneous Comparison of Outcomes Among Patients Implanted With a Leadless vs Transvenous Single\u2010Chamber Ventricular Pacemaker","volume":"6","author":"Piccini J. P.","year":"2021","journal-title":"JAMA Cardiology"},{"issue":"7","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.hrthm.2018.04.022","article-title":"Comparative Study of Acute and Mid\u2010Term Complications With Leadless and Transvenous Cardiac Pacemakers","volume":"15","author":"Cantillon D. J.","year":"2018","journal-title":"Heart Rhythm"},{"issue":"6","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1056\/NEJMoa1511643","article-title":"A Leadless Intracardiac Transcatheter Pacing System","volume":"374","author":"Reynolds D.","year":"2016","journal-title":"New England Journal of Medicine"},{"issue":"9","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.hrthm.2017.05.017","article-title":"A Leadless Pacemaker in the Real\u2010World Setting: The Micra Transcatheter Pacing System Post\u2010Approval Registry","volume":"14","author":"Roberts P. R.","year":"2017","journal-title":"Heart Rhythm"},{"issue":"7","key":"e_1_2_9_13_1","first-page":"1187","article-title":"1\u2010Year Outcomes of a Leadless Ventricular Pacemaker","volume":"9","author":"Reddy V. Y.","year":"2023","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"12","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1056\/NEJMoa1507192","article-title":"Percutaneous Implantation of an Entirely Intracardiac Leadless Pacemaker","volume":"373","author":"Reddy V. Y.","year":"2015","journal-title":"New England Journal of Medicine"},{"issue":"10","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1016\/j.hrthm.2024.06.008","article-title":"A Leadless Ventricular Pacemaker Providing Atrioventricular Synchronous Pacing in the Real\u2010World Setting: 12\u2010Month Results From the Micra AV Post\u2010Approval Registry","volume":"21","author":"Garweg C.","year":"2024","journal-title":"Heart Rhythm"},{"issue":"12","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/j.hrthm.2018.08.005","article-title":"Updated Performance of the Micra Transcatheter Pacemaker in the Real\u2010World Setting: A Comparison to the Investigational Study and a Transvenous Historical Control","volume":"15","author":"El\u2010Chami M. F.","year":"2018","journal-title":"Heart Rhythm"},{"issue":"10","key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1093\/europace\/euac066","article-title":"Practical Considerations, Indications, and Future Perspectives for Leadless and Extravascular Cardiac Implantable Electronic Devices: A Position Paper by EHRA\/HRS\/LAHRS\/APHRS","volume":"24","author":"Boersma L. V.","year":"2022","journal-title":"Europace"},{"issue":"1","key":"e_1_2_9_18_1","article-title":"The Unstable Pacing Thresholds of the Leadless Transcatheter Pacemaker Affected by Body Positions in Subacute Phase After Implant","volume":"3","author":"Yoh M.","year":"2019","journal-title":"European Heart Journal Case Reports"},{"issue":"6","key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1056\/NEJMoa1511643","article-title":"A Leadless Intracardiac Transcatheter Pacing System","volume":"374","author":"Reynolds D.","year":"2016","journal-title":"New England Journal of Medicine"},{"issue":"8","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.hrcr.2023.05.017","article-title":"A Broken Tine as a Possible Explanation for Rise in Pacing Threshold in a Leadless Pacemaker","volume":"9","author":"Doshi R. N.","year":"2023","journal-title":"HeartRhythm Case Reports"},{"issue":"3","key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.hrcr.2021.12.004","article-title":"Rate\u2010Dependent Change in Capture Threshold Following Implantation of a Leadless Pacemaker","volume":"8","author":"Nusbickel A. J.","year":"2022","journal-title":"HeartRhythm Case Reports"},{"issue":"11","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1111\/pace.14080","article-title":"Predictors of Increase in Pacing Threshold After Transcatheter Pacing System Implantation Due to Micro\u2010Dislodgement","volume":"43","author":"Higuchi M.","year":"2020","journal-title":"Pacing and Clinical Electrophysiology"},{"issue":"12","key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1016\/j.hrthm.2020.07.035","article-title":"Morbidity and Mortality in Patients Precluded for Transvenous Pacemaker Implantation: Experience With a Leadless Pacemaker","volume":"17","author":"Garg A.","year":"2020","journal-title":"Heart Rhythm"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70333","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70333","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70333","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:50:59Z","timestamp":1782985859000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70333"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":22,"alternative-id":["10.1111\/pace.70333"],"URL":"https:\/\/doi.org\/10.1111\/pace.70333","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"assertion":[{"value":"2026-02-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70333"}}