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Clinical outcome for heart failure hospitalizations in patients with leadless pacemaker. Journal of arrhythmia Introduction:The long-term performance of leadless pacemaker (LPM) has not been well evaluated. Methods:Between September 2017 and January 2021, 929 consecutive patients who underwent pacemaker implantation were grouped according to the types of pacemakers: LPM (LPM group,  = 368) and conventional pacemaker (PM group,  = 561). Results:The median follow-up duration was 1.7 years (interquartile range 0.8-2.6 years). Hospitalization rate for heart failure in the LPM group was 9.3%, 15.6%, and 21.6% at 1, 2, 3 years, respectively. The LPM group had a significantly higher adjusted heart failure hospitalization risk than the PM group [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.09-2.64,  = .01]. More patients with symptomatic bradycardia caused by sinus node dysfunction (SND) in the LPM group ( = 150) were admitted to the hospital for heart failure compared to those in the PM group ( = 219) (HR 2.02, 95%CI 1.04-3.90,  = .03), whereas no significant difference was observed between the two groups in the patients with bradycardia caused by atrial fibrillation (LPM group,  = 71; PM group,  = 18) or atrioventricular block (LPM group,  = 147; PM group,  = 324). Conclusions:Patients who received LPM implantation had greater hospitalization risk for heart failure, compared to those who received conventional pacemaker implantation. The increased risk was mainly attributed to patients with SND. 10.1002/joa3.12761