AbstractIntroductionLeadless pacemakers (LPM) have established themselves as the important therapeutic modality in management of selected patients with symptomatic bradycardia. To determine real‐world utilization and in‐hospital outcomes of LPM implantation since its approval by the Food and Drug Administration in 2016.MethodsFor this retrospective cohort study, data were extracted from the National Inpatient Sample database from the years 2016−2020. The outcomes analyzed in our study included implantation trends of LPM over study years, mortality, major complications (defined as pericardial effusion requiring intervention, any vascular complication, or acute kidney injury), length of stay, and cost of hospitalization. Implantation trends of LPM were assessed using linear regression. Using years 2016−2017 as a reference, adjusted outcomes of mortality, major complications, prolonged length of stay (defined as >6 days), and increased hospitalization cost (defined as median cost >34 098$) were analyzed for subsequent years using a multivariable logistic regression model.ResultsThere was a gradual increased trend of LPM implantation over our study years (3230 devices in years 2016−2017 to 11 815 devices in year 2020, p for trend <.01). The adjusted mortality improved significantly after LPM implantation in subsequent years compared to the reference years 2016−2017 (aOR for the year 2018: 0.61, 95% CI: 0.51−0.73; aOR for the year 2019: 0.49, 95% CI: 0.41−0.59; and aOR for the year 2020: 0.52, 95% CI: 0.44−0.62). No differences in adjusted rates of major complications were demonstrated over the subsequent years. The adjusted cost of hospitalization was higher for the years 2019 (aOR: 1.33, 95% CI: 1.22−1.46) and 2020 (aOR: 1.69, 95% CI: 1.55−1.84).ConclusionThe contemporary US practice has shown significantly increased implantation rates of LPM since its approval with reduced rates of inpatient mortality.