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Ueyama HA, Miyamoto Y, Hashimoto K, Watanabe A, Kolte D, Latib A, Kuno T, Tsugawa Y. Comparison of Patient Outcomes Between Leadless vs Transvenous Pacemakers Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024; 17:1779-1791. [PMID: 39023453 DOI: 10.1016/j.jcin.2024.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/23/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Evidence is limited regarding the effectiveness of leadless pacemaker implantation for conduction disturbance following transcatheter aortic valve replacement (TAVR). OBJECTIVES This study sought to examine the national trends in the use of leadless pacemaker implantation following TAVR and compare its performance with transvenous pacemakers. METHODS Medicare fee-for-service beneficiaries aged ≥65 years who underwent leadless or transvenous pacemakers following TAVR between 2017 and 2020 were included. Outcomes included in-hospital overall complications as well as midterm (up to 2 years) all-cause death, heart failure hospitalization, infective endocarditis, and device-related complications. Propensity score overlap weighting analysis was used. RESULTS A total of 10,338 patients (730 leadless vs 9,608 transvenous) were included. Between 2017 and 2020, there was a 3.5-fold increase in the proportion of leadless pacemakers implanted following TAVR. Leadless pacemaker recipients had more comorbidities, including atrial fibrillation and end-stage renal disease. After adjusting for potential confounders, patients with leadless pacemakers experienced a lower rate of in-hospital overall complications compared with patients who received transvenous pacemakers (7.2% vs 10.1%; P = 0.014). In the midterm, we found no significant differences in all-cause death (adjusted HR: 1.13; 95% CI: 0.96-1.32; P = 0.15), heart failure hospitalization (subdistribution HR: 0.89; 95% CI: 0.74-1.08; P = 0.24), or infective endocarditis (subdistribution HR: 0.98; 95% CI: 0.44-2.17; P = 0.95) between the 2 groups, but leadless pacemakers were associated with a lower risk of device-related complications (subdistribution HR: 0.37; 95% CI: 0.21-0.64; P < 0.001). CONCLUSIONS Leadless pacemakers are increasingly being used for conduction disturbance following TAVR and were associated with a lower rate of in-hospital complications and midterm device-related complications compared to transvenous pacemakers without a difference in midterm mortality.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsuyuki Watanabe
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York, USA
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA; Department of Health Policy and Management, University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, USA
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Oliveira VMR, Rivera A, Oliveira IC, de Sousa AM, Nishikubo MEP, Serpa F, da Silva Menezes Junior A. The Effectiveness and Safety of Leadless Pacemakers: An Updated Meta-Analysis. Curr Cardiol Rep 2024; 26:789-799. [PMID: 38869811 DOI: 10.1007/s11886-024-02079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Leadless pacemakers (LPs) are promising alternatives to traditional transvenous pacemakers (TVPs), but their comparative effectiveness and safety in clinical outcomes remain uncertain. METHODS We systematically searched PubMed, Embase, Scopus, Cochrane, and ClinicalTrials.gov for studies comparing LPs and TVPs. A restricted maximum likelihood random-effects model was used for all outcomes. Heterogeneity was assessed using I2 statistics. We performed a subgroup analysis with studies with multivariate-adjusted data. RESULTS We included 21 studies involving 47,229 patients, of whom 12,199 (25.8%) underwent LP implantation. Compared with TVPs, LPs were associated with a significantly lower risk of overall complications (OR 0.61; 95% CI 0.45-0.81; p < 0.01), dislodgement (OR 0.34; 95% CI 0.20-0.56; p < 0.01), and pneumothorax (OR 0.27; 95% CI 0.16-0.46; p < 0.01). No significant difference in all-cause mortality was observed in the overall analysis (OR 1.43; 95% CI 0.65-3.15; p = 0.35) and in studies with multivariate-adjusted data (OR 1.34; 95% CI 0.65-2.78; p = 0.43). However, LPs were associated with a higher risk of pericardial effusion (OR 2.47; 95% CI 1.39-4.38; p < 0.01) and cardiac tamponade (OR 3.75; 95% CI 2.41-5.83; p < 0.01). LPs also demonstrated a lower pacing capture threshold (MD -0.19 V; 95% CI [-0.23 V]-[-0.16 V]; p < 0.01), but no significant difference in impedance (MD 32.63 ohms; 95% CI [-22.50 ohms]-[87.76 ohms]; p = 0.25). CONCLUSIONS These findings suggest that LPs were associated with lower overall complication rates and similar effectiveness to TVPs. However, randomized controlled trials are warranted to validate these results.
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Affiliation(s)
| | - André Rivera
- Department of Medicine, Nove de Julho University, São Bernardo Do Campo, Brazil
| | | | | | | | - Frans Serpa
- Division of Cardiology, Beth Israel Deaconess Center, Harvard Medical School, Boston, USA
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Segreti L, Torre M, Parollo M, Fiorentini F, Di Cori A, Zucchelli G. Optimizing cardiac device management: Leadless pacemaker implantation together with an implantable cardioverter-defibrillator lead in a diaphragmatic stimulation case. HeartRhythm Case Rep 2024; 10:494-497. [PMID: 39129747 PMCID: PMC11312034 DOI: 10.1016/j.hrcr.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Affiliation(s)
- Luca Segreti
- Address reprint requests and correspondence: Dr Luca Segreti, Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy.
| | | | - Matteo Parollo
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Federico Fiorentini
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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Xu F, Meng L, Lin H, Xu W, Guo H, Peng F. Systematic review of leadless pacemaker. Acta Cardiol 2024; 79:284-294. [PMID: 37961771 DOI: 10.1080/00015385.2023.2276537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
Conventional pacing systems consist of a pacemaker and one or more leads threaded from the device pocket through veins into the heart conducting the pacing therapy to the desired pacing site. Although these devices are effective, approximately one in eight patients treated with these traditional pacing systems experiences a complication attributed to the pacemaker pocket or leads. With the technological advances in electronics, leadless pacemakers that small enough to implant within the heart were introduced. Leadless pacemakers have been developed to overcome many of the challenges of transvenous pacing including complications related to leads or pacemaker pockets. This review aims to provide an overview of advantages of leadless pacemaker, complications and limitations of leadless pacemaker, leadless pacemaker candidate, and future directions of this promising technology.
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Affiliation(s)
- Fukang Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Liping Meng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hui Lin
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Weiyuan Xu
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Hangyuan Guo
- Shaoxing Wen li Medical College, Shaoxing, China
| | - Fang Peng
- Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
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Habboush S, Elmoursi A, Gadelmawla AF, Masoud AT, Khalil M, Sheashaa H, Merza N, Massoud AT. Transvenous Compared With Leadless Pacemakers: A meta-analysis comparing TP versus LP. Cardiol Rev 2024:00045415-990000000-00202. [PMID: 38299806 DOI: 10.1097/crd.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
This study aims to compare the effectiveness of leadless pacemakers (LPs) and transvenous pacemakers and to examine the safety of both methods. We included patients undergoing single-chamber pacemaker implantation, either LP or TVP. Our outcomes were successful implantation rate, major complication, vascular injury, tamponade, and pneumothorax. We performed a double-arm analysis comparing LP versus TVP, with risk ratio (RR) and 95% confidence interval. A total of 10 studies were included in this meta-analysis. Regarding efficacy endpoints, RR revealed no significant difference between the LP and transvenous pacemaker groups in terms of successful rate of implantation (RR = 1.00; P = 0.77). Regarding safety outcomes, LP experienced lower incidence of major complications (RR = 0.47; P = 0.01), infection (RR = 0.24; P = 0.001), and tamponade (RR = 0.36; P = 0.01). There was no significant difference between both groups regarding pneumothorax (RR = 0.35; P = 0.22) and vascular injury (RR = 1.55; P = 0.25). The study findings suggest that both LPs and TVPs have similar effectiveness. Moreover, the incidences of pneumothorax, vascular injuries, and major complications were found to be comparable between the 2 methods. However, LPs were found to have lower rates of infection and tamponade.
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Affiliation(s)
- Shady Habboush
- From the Department of cardiology, Marien Hospital Witten, Witten, Germany
| | - Ahmed Elmoursi
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ahmed F Gadelmawla
- Department of Cardiology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amr T Masoud
- Department of Medical Research, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mohamed Khalil
- Department of Cardiology, Faculty of Medicine, Cairo University, Menoufia, Egypt
| | - Hesham Sheashaa
- Internal Medicine Department, University of Toledo, Toledo, OH
| | - Nooraldin Merza
- Internal Medicine Department, University of Toledo, Toledo, OH
| | - Ahmed T Massoud
- Department of Medical Research, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Mitacchione G, Migliore F. Co-presence of subcutaneous implantable cardioverter-defibrillator and leadless pacemaker in high-risk infection patients: are we out of the woods? J Interv Card Electrophysiol 2024:10.1007/s10840-023-01726-2. [PMID: 38227124 DOI: 10.1007/s10840-023-01726-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024]
Affiliation(s)
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padua, Italy.
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Shtembari J, Shrestha DB, Awal S, Raut A, Gyawali P, Abe T, Patel NK, Deshmukh A, Voruganti D, Bhave PD, Whalen P, Pothineni NVK, Shantha G. Comparative assessment of safety with leadless pacemakers compared to transvenous pacemakers: a systemic review and meta-analysis. J Interv Card Electrophysiol 2023; 66:2165-2175. [PMID: 37106267 DOI: 10.1007/s10840-023-01550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Leadless pacemakers (LP) and transvenous pacemakers (TVP) are two stable pacing platforms currently available in clinical practice. Observational data show mixed results with regards to their comparative safety. This meta-analysis was aimed to evaluate the comparative safety of LP over TVP. METHODS The study protocol was registered in PROSPERO registry (CRD42022325376). Six databases were searched for published literature from inception to April 12, 2022. RevMan 5.4.1 was used for statistical analysis. Odds ratio (OR) and mean difference were used to estimate the outcome with a 95% confidence interval (CI). RESULTS A total of 879 studies were imported from the databases. Among these, 41 papers were screened for full text and 17 meet the inclusion criteria. Among them, pooled results showed 42% lower odds of occurrence of complications in the LP group (OR 0.58, CI 0.42-0.80) compared to TVP group. Notably, 70% lower odds of device dislodgment (OR 0.30, CI 0.21-0.43), 46% lower odds of re-intervention (OR 0.54, CI 0.45-0.64), 87% lower odds of pneumothorax (OR 0.13, CI 0.03-0.57), albeit, 2.65 times higher odds of pericardial effusion (OR 2.65, CI 1.49-4.70) were observed in the LP group. CONCLUSIONS This meta-analysis showed LP to be a significantly safer modality compared to TVP, in terms of re-intervention, device dislodgment, pneumothoraxes, and overall complications. However, there were higher rates of pericardial effusion in the LP group. There was a diverse number of patients included, and all studies were observational. Randomized trials are needed to validate our findings.
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Affiliation(s)
- Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA
| | | | - Shila Awal
- Department of Internal Medicine, Suryabinayak Municipal Hospital, Suryabinayak, Nepal
| | - Anuradha Raut
- Department of Internal Medicine, Nepal Medical College, Kathmandu, Nepal
| | - Pratik Gyawali
- Department of Internal Medicine, Om Saibaba Memorial Hospital, Kathmandu, Nepal
| | - Temidayo Abe
- Department of Internal Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Abhishek Deshmukh
- Department of Cardiology, Division of Electrophysiology, Mayo Clinic, Rochester, MN, USA
| | - Dinesh Voruganti
- Department of Internal Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Prashant Dattatraya Bhave
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Patrick Whalen
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | | | - Ghanshyam Shantha
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA.
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8
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Gangannapalle M, Monday O, Rawat A, Nwoko UA, Mandal AK, Babur M, Khan TJ, Palleti SK. Comparison of Safety of Leadless Pacemakers and Transvenous Pacemakers: A Meta-Analysis. Cureus 2023; 15:e45086. [PMID: 37842352 PMCID: PMC10568652 DOI: 10.7759/cureus.45086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Pacemakers have been accessible for six decades, and clearly defined criteria for pacemaker implantation have been established. Within the contemporary clinical practice, two dependable pacing platforms exist leadless pacemakers and transvenous pacemakers. The aim of this meta-analysis is to compare the safety of leadless pacemakers to transvenous pacemakers. This meta-analysis adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework. A comprehensive and systematic search was conducted across various databases including Scopus, Cochrane Library, and EMBASE, spanning from inception to August 15, 2023. The primary outcomes assessed in this meta-analysis were total complications, all-cause mortality, and device-related complications. Furthermore, secondary outcomes evaluated encompassed the need for reintervention, occurrences of pneumothorax, pericardial effusion, endocarditis, hemothorax, and hematoma. Total 17 studies were included in this meta-analysis. The findings of this study showed that patients with leadless pacemakers had a lower risk of total complications, device-related complications, pneumothorax, and endocarditis. The risk of reintervention was significantly lower in the leadless pacemaker group. However, compared to a transvenous pacemaker, the risk of pericardial effusion was significantly higher in the leadless pacemaker group. It is important to acknowledge the limitations arising from the lack of extensive long-term follow-up data for leadless pacemakers. As technology evolves, continued research will be essential in uncovering the full spectrum of prolonged complications associated with these devices.
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Affiliation(s)
| | - Obinna Monday
- Medicine, Norfolk and Norwich University, Norwich, GBR
| | - Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Dehradun, IND
| | - Ugonna A Nwoko
- Medicine, American University of the Caribbean School of Medicine, Cupicoy, SXM
| | | | - Maham Babur
- Internal Medicine, Women Medical and Dental College, Abbottabad, PAK
| | - Tayyaba J Khan
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Sujith K Palleti
- Nephrology, Louisiana State University Health Sciences Center, Shreveport, USA
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Palmisano P, Facchin D, Ziacchi M, Nigro G, Nicosia A, Bongiorni MG, Tomasi L, Rossi A, De Filippo P, Sgarito G, Verlato R, Di Silvestro M, Iacopino S. Rate and nature of complications with leadless transcatheter pacemakers compared with transvenous pacemakers: results from an Italian multicentre large population analysis. Europace 2023; 25:112-120. [PMID: 36036679 PMCID: PMC10103553 DOI: 10.1093/europace/euac112] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The safety and efficacy of leadless intracardiac-permanent pacemaker (L-PM) have been demonstrated in multiple clinical trials, but data on comparisons with conventional transvenous-permanent pacemaker (T-PM) collected in a consecutive, prospective fashion are limited. The aim of this analysis was to compare the rate and the nature of device-related complications between patients undergoing L-PM vs. T-PM implantation. METHODS AND RESULTS Prospective, multicentre, observational project enrolling consecutive patients who underwent L-PM or T-PM implantation. The rate and nature of device-related complications were analysed and compared between the two groups. Individual 1:1 propensity matching of baseline characteristics was performed. A total of 2669 (n = 665 L-PM) patients were included and followed for a median of 39 months, L-PM patients were on average older and had more co-morbidities. The risk of device-related complications at 12 months was significantly lower in the L-PM group (0.5% vs. 1.9%, P = 0.009). Propensity matching yielded 442 matched pairs. In the matched cohort, L-PM patients trended toward having a lower risk of overall device-related complications (P = 0.129), had a similar risk of early complications (≤30 days) (P = 1.000), and had a significantly lower risk of late complications (>30 days) (P = 0.031). All complications observed in L-PM group were early. Most (75.0%) of complications observed in T-PM group were lead- or pocket-related. CONCLUSION In this analysis, the risk of device-related complications associated with L-PM implantation tended to be lower than that of T-PM. Specifically, the risk of early complications was similar in two types of PMs, while the risk of late complications was significantly lower for L-PM than T-PM.
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Affiliation(s)
| | - Domenico Facchin
- SOC Cardiologia-Dipartimento Cardiotoracico, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Matteo Ziacchi
- Istituto di Cardiologia, Policlinico Sant'Orsola Malpighi, Università degli Studi di Bologna, Bologna, Italy
| | | | - Antonino Nicosia
- Azienda Sanitaria Provinciale, Ospedale Giovanni Paolo II, Ragusa, Italy
| | | | - Luca Tomasi
- Azienda Ospedaliera Universitaria, Ospedale Borgo Trento, Verona, Italy
| | - Andrea Rossi
- Fondazione Toscana Gabriele Monasterio, Pisa.Italy
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10
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Palmisano P, Iacopino S, De Vivo S, D'Agostino C, Tomasi L, Startari U, Ziacchi M, Pisanò ECL, Santobuono VE, Caccavo VP, Sgarito G, Rillo M, Nicosia A, Zucchelli G. Leadless transcatheter pacemaker: Indications, implantation technique and peri-procedural patient management in the Italian clinical practice. Int J Cardiol 2022; 365:49-56. [PMID: 35907505 DOI: 10.1016/j.ijcard.2022.07.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/03/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Safety and efficacy of leadless pacemakers (L-PM) have been demonstrated in multiple clinical trials, but real-world data on patient selection, implantation technique, and peri-procedural patient management in a clinical practice setting are lacking. METHODS Consecutive patients undergoing L-PM implantation in 14 Italian centers were followed in a prospective, multicentre, observational project. Data on baseline patient characteristics, clinical indications, implantation procedure, and peri-procedural patient management were collected. The rate and nature of device-related complications were also recorded. RESULTS A total of 782 L-PM patients (68.4% male, 75.6 ± 12.4 years) were included in the analysis. The main patients-related reason leading to the choice of implanting a L-PM rather than a conventional PM was the high-risk of device infection (29.5% of cases). The implantation success rate was 99.2%. The median duration of the procedure was 46 min. In 90% of patients the device was implanted in the septum. Of patients on oral anticoagulant therapy (OAT) (n = 498) the implantation procedure was performed without interrupting (17.5%) or transiently interrupting OAT without heparin bridging (60.6%). During a median follow-up of 20 months major device-related complications occurred in 7 patients (0.9%): vascular access-site complications in 3 patients, device malfunction in 2 patients, pericardial effusion/cardiac tamponade in one patient, device migration in one patient. CONCLUSIONS In the real world setting of Italian clinical practice L-PM is often reserved for patients at high-risk of infection. The implantation success rate was very high and the risk of major complications was low. Peri-procedural management of OAT was consistent with available scientific evidence.
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Affiliation(s)
| | | | | | | | - Luca Tomasi
- U.O.C. Cardiologia - Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Matteo Ziacchi
- Istituto di Cardiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | | | | | - Antonino Nicosia
- Azienda Sanitaria Provinciale, Ospedale Giovanni Paolo II, Ragusa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiothoracic and Vascular department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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11
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Hauser RG, Gornick CC, Abdelhadi RH, Tang CY, Kapphahn‐Bergs M, Casey SA, Okeson BK, Steele EA, Sengupta JD. Leadless pacemaker perforations: Clinical consequences and related device and user problems. J Cardiovasc Electrophysiol 2022; 33:154-159. [PMID: 34953099 PMCID: PMC9305184 DOI: 10.1111/jce.15343] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiac perforation during leadless pacemaker implantation is more likely to require intervention than perforation by a transvenous lead. This study reports the consequences of Micra pacemaker perforations and related device and operator use problems based on information the manufacturer has submitted to the Food and Drug Administration (FDA). METHODS FDA's Manufacturer and User Facility Device Experience (MAUDE) database was searched for Micra perforations. Data extracted included deaths, major adverse clinical events (MACEs), and device and/or operator use problems. RESULTS Between 2016 and July 2021, 563 perforations were reported within 30 days of implant and resulted in 150 deaths (27%), 499 cardiac tamponades (89%), 64 pericardial effusions (11%), and 146 patients (26%) required emergency surgery. Half of perforations were associated with 139 (25%) device problems, 78 (14%) operator use problems, and 62 (11%) combined device and operator use problems. Inadequate electrical measurements or difficult positioning were the most frequent device problems (n = 129); non-septal implants and perforation of other structures were the most frequent operator use problems (n = 69); a combined operator use and device problem resulted in 62 delivery system perforations. No device or operator use problem was identified for 282 perforations (50%), but they were associated with 78 deaths, 245 tamponades, and 57 emergency surgeries. CONCLUSION The Micra perforations reported in MAUDE are often associated with death and major complications requiring emergency intervention. Device and use problems account for at least half of perforations. Studies are needed to identify who is at risk for a perforation and how MACE can be avoided or mitigated.
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Affiliation(s)
- Robert G. Hauser
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Charles C. Gornick
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Raed H. Abdelhadi
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Chuen Y. Tang
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Melanie Kapphahn‐Bergs
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Susan A. Casey
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Brynn K. Okeson
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Elizabeth A. Steele
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Jay D. Sengupta
- Heart Rhythm Science CenterMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
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Abstract
Leadless pacemakers (LPs) have revolutionized the field of pacing by miniaturizing pacemakers and rendering them completelty intracardiac, hence reducing complications related to pacemaker pockets and transvenous leads. However, first generation LPs appear to be associated with a higher rate of myocardial perforation as compared to transvenous pacemakers (TV-PPM). Currently, LPs are predominantly designed to pace the right ventricle with no LPs that provide atrial or biventricular pacing. In this article, we review the available data on LPs while advocating for the need for a randomized controlled trial comparing LPs to TV-PPMs. In addition, we review the future directions of leadless devices.
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Greason KL. Commentary: How many doctors does it take to change a lightbulb? J Thorac Cardiovasc Surg 2020; 163:1826. [PMID: 32919764 DOI: 10.1016/j.jtcvs.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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