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Aguayo JA, Cortez D. Atrial placement of Aveir-VR leadless pacemaker in a patient with complex cardiac anatomy. Indian Pacing Electrophysiol J 2024; 24:204-206. [PMID: 38697395 PMCID: PMC11361867 DOI: 10.1016/j.ipej.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/05/2024] Open
Abstract
Leadless pacemakers have provided new treatment modalities that can be especially useful in patients with complex cardiac anatomy and contraindications toward other pacemaker approaches. The Aveir™ single-chamber (VR) leadless pacemaker (LP) (Abbott Laboratories, Chicago, IL) is a recently approved device that can be placed in the right ventricle for patients with bradycardia. In this case, we present a novel use for the device through placement in the atrium to control atrial flutter in a patient with a hypoplastic right ventricle.
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Affiliation(s)
| | - Daniel Cortez
- Adult Congenital Cardiology, UC Davis Medical Center, Sacramento, USA.
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Sherwin ED, Shah MJ. Leadless Pacemakers in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:421-432. [PMID: 37865516 DOI: 10.1016/j.ccep.2023.06.002] [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] [Indexed: 10/23/2023]
Abstract
Transcatheter leadless pacemakers have benefits in congenital heart disease because they eliminate the risks of lead malfunction, venous occlusions, and pocket complications. This newest pacemaker's utility in this population has been limited by the large sheath and delivery system, need for atrioventricular synchronous pacing, lack of explantation options, and possible lack of adequate access to the subpulmonary ventricle. With careful planning, leadless pacing can be successfully performed in these patients. Consideration of nonfemoral access, alternative implant sites to avoid myocardial scar or prosthetic material, anticoagulation for patients with persistent intracardiac shunts or systemic ventricular implantation, and operator experience are critical.
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Affiliation(s)
- Elizabeth D Sherwin
- Division of Pediatric Cardiology, Children's National Hospital, Division of Cardiology Washington, 111 Michigan Avenue, NW, Washington, DC 20010, USA
| | - Maully J Shah
- Cardiac Electrophysiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Lancini D, Smith C, Elkhateeb O, Sapp J, Parkash R. Leadless Micra pacemaker implantation in patient with previous Senning procedure for dextro-transposition of the great arteries. Acta Cardiol 2023; 78:357-361. [PMID: 36803008 DOI: 10.1080/00015385.2023.2176043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Leadless pacemakers have been developed with key advantages over traditional transvenous pacemakers by substantially mitigating the risks of device infection and lead related complications, and providing an alternative pacing strategy in patients with barriers to superior venous access. The Medtronic Micra leadless pacing system is designed for implantation through a femoral venous approach across the tricuspid valve, via Nitinol tine fixation into the trabeculated subpulmonic right ventricle. Patients with surgically corrected dextro-transposition of the great arteries (d-TGA) have an increased risk of pacing requirement. There is limited published experience of implantation of leadless Micra pacemakers in this population, with key challenges relating to trans-baffle access, and deployment of the device into the less trabeculated subpulmonic left ventricle. Here we describe a case report of leadless Micra implantation in a 49 year old male with d-TGA and Senning procedure in childhood, who required pacing for symptomatic sinus node disease, with anatomic barriers to transvenous pacing. Micra implantation was successfully performed following careful consideration of patient anatomy, including the utilisation of 3D modelling to guide the implantation procedure.
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Affiliation(s)
- Daniel Lancini
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Corey Smith
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Osama Elkhateeb
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - John Sapp
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Department of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Calvert P, Yeo C, Rao A, Neequaye S, Mayhew D, Ashrafi R. Transcarotid implantation of a leadless pacemaker in a patient with Fontan circulation. HeartRhythm Case Rep 2022; 9:53-58. [PMID: 36685685 PMCID: PMC9845646 DOI: 10.1016/j.hrcr.2022.10.018] [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: 11/06/2022] Open
Affiliation(s)
- Peter Calvert
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Cheng Yeo
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Archana Rao
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Simon Neequaye
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Liverpool University Hospitals Foundation Trust, Royal Liverpool Hospital, Liverpool, United Kingdom
| | - David Mayhew
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Reza Ashrafi
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Address reprint requests and correspondence: Dr Reza Ashrafi, Northwest Congenital Heart Disease Partnership, Liverpool Heart & Chest Hospital, Thomas Dr, Liverpool, England, UK L14 3PE.
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Shah RS, Davidson WR, Samii SM. Leadless pacemaker implantation in a subpulmonic left ventricle in a patient with congenitally corrected transposition of the great arteries. HeartRhythm Case Rep 2022; 8:471-474. [PMID: 35860776 PMCID: PMC9289060 DOI: 10.1016/j.hrcr.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Okabe T, Afzal MR, Houmsse M, Makary MS, Elliot ED, Daoud EG, Augostini RS, Hummel JD. Tine-Based Leadless Pacemaker: Strategies for Safe Implantation in Unconventional Clinical Scenarios. JACC Clin Electrophysiol 2021; 6:1318-1331. [PMID: 33092762 DOI: 10.1016/j.jacep.2020.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
Leadless pacemakers (LPs) have emerged as a meaningful alternative to transvenous pacemakers for single-ventricular pacing. LPs eliminate many of lead- and pocket-associated complications observed with transvenous pacemakers. Owing to the lack of atrioventricular synchronous pacing until recently, the use of LP was generally reserved for those patients who either required minimal ventricular pacing or had permanent atrial fibrillation. The only commercially available LP is the Micra transcatheter pacing system (Micra-TPS, Medtronic Inc. Fridley, Minnesota), which requires insertion of a 27-F (outer diameter) introducer sheath in the femoral vein. The LP is delivered to the right ventricle using a 23-F delivery catheter. Owing to the need for a large-bore sheath, the pivotal studies for the Micra transcatheter pacing system excluded patients with indwelling inferior vena cava filters and included only a few patients with bioprosthetic or repaired tricuspid valve. Subsequent real-world experience has demonstrated the overall safety and feasibility of LP placement, and use in various unconventional clinical settings has been validated, albeit with specific precautions. Additionally, incorporation of adjunctive techniques and strategies can improve the safety of the procedure in routine clinical settings as well. The objective of this state-of-the-art review is to highlight the key procedural elements to facilitate safe and efficient implantation of LP in routine as well as in unique clinical settings.
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Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric D Elliot
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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