Body Mass Index, Frailty, and Outcomes in Leadless Pacemaker Implantation

not-yet-known not-yet-known not-yet-known unknown Background: The association between body mass index (BMI) and frailty in the context of leadless pacemaker (LPM) implantation remains underexplored. Objective: This study aims to investigate the relationship between BMI, frailty, and outcomes in patients who underwent LPM implantation. Methods: Data from the National Inpatient Sample (NIS) from 2018-2021 was analyzed for patients who underwent LPM implantation. Patients were categorized into five BMI groups: underweight, normal weight, overweight, obese, and morbidly obese. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Results: The study included a weighted cohort of 8,865 patients who underwent LPM implantation. Among frail patients (n=6120), mortality occurred in 5.0% of obese individuals compared to 7.5% in non-obese individuals (aOR: 0.763, 95% CI: 0.601-0.968). Frail, obese patients showed reduced risks of venous thromboembolism (aOR: 0.760, 95% CI: 0.565-0.943), the need for blood transfusions (aOR: 0.826, 95% CI: 0.690-0.988), and pericardial complications (aOR: 0.778, 95% CI: 0.564-0.925), but demonstrated elevated risks of renal complications (aOR: 1.284, 95% CI: 1.132-1.458) and device removal/revision (aOR: 2.121, 95% CI: 1.943-2.345). Notably, obese individuals were significantly less likely to be classified as frail (aOR: 0.591, 95% CI: 0.124-0.739, p<0.001), with 65% of obese and 78.1% of non-obese individuals being frail. Conclusion: This study demonstrates that frail, obese patients who underwent LPM implantation, exhibited a lower risk of mortality and complications compared to non-obese individuals, despite facing a higher likelihood of renal complications and device-related issues. Furthermore, it was found that frail patients had a lower prevalence of obesity.