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Device-related infections constitute a major complication of transvenous pacemaker implantation. Mechanical heart valves (MHV) increase the risk of infective endocarditis (IE) and pacemaker infection, worsening their outcomes.Leadless pacemakers (LP) have been associated with low infection rates and thus pose an attractive option in MHV patients requiring permanent pacing. Methods and results This is a multicenter, observational, retrospective study including all consecutive patients implanted with an LP at 5 tertiary referral centers between June 2015 and January 2020.Procedural outcomes, complications, performance during follow-up and episodes of bacteremia and IE were recorded and compared between patients with and without a MHV (MHV and non-MHV groups).Four hundred fifty-nine patients were included (74 in the MHV group, 16.1%, and 385 in the non-MHV group, 83.9%).Implantation success, procedural outcomes and acute electrical performance were comparable between groups.Vascular complications and cardiac perforation occurred in 2.7 vs. 2.3% (p=1) and 0% vs. 0.8% (p=1) in the MHV group and non-MHV group, respectively.During a median post-implant follow-up of 308 days for the MHV group and 416 days for non-MHV patients (p=0.029), one case of IE was reported in the MHV group and 2 in the non-MHV group. All three occurred in patients with abandoned transvenous leads. Conclusion LP implantation is feasible and safe in patients with MHV, with procedural outcomes and electrical performance comparable to the general LP population. Device-related infections, including IE, are rare in patients receiving an LP, including those with an MHV. LP implantation should be considered in MHV patients with an indication for pacing. Funding Acknowledgement Type of funding sources: None. Procedural outcomes and complicationsBaseline and follow-up parameters

Outcomes of leadless pacemaker implantation in patients with mechanical heart valves