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Goto K, Kojima T, Oshima T, Saito A, Shimizu Y, Soma K, Nakayama Y, Hasumi E, Inuzuka R, Ando M, Amiya E, Fujiu K, Hirata Y, Hatano M, Ono M, Komuro I. A leadless pacemaker implantation for a patient with systemic right ventricle under ventricular assist device support. J Cardiol Cases 2024; 29:244-247. [PMID: 38826767 PMCID: PMC11143719 DOI: 10.1016/j.jccase.2024.02.004] [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: 09/28/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 06/04/2024] Open
Abstract
Patients with congenitally corrected transposition of the great arteries (ccTGA) often develop complete atrioventricular block and heart failure due to the abnormal disposition of atrioventricular node and disadvantage of systemic right ventricle. These issues are managed with a pacing system and a ventricular assist device (VAD), respectively. While technological advances offer new treatment strategies, the simultaneous deployment of a leadless pacemaker and a VAD in cases of ccTGA remains unexplored. Here, we present a case of leadless pacemaker implantation for a VAD-supported ccTGA patient. The safety of a leadless pacemaker for a subpulmonary left ventricle and electromagnetic interference between devices are major concerns when implanting a leadless pacemaker; however, the current case overcomes these obstacles. There were no perioperative complications, and both devices were functioning without problems during a one-year follow up. We expect that, even in patients with cardiac complexity such as systemic right ventricle under VAD support, a leadless pacemaker could become the treatment of choice if the indication is appropriate, although careful and close follow up is needed. Learning objective Technological advances expand treatment strategies and provide significant benefits to patients with adult congenital heart disease (ACHD). However, discussion of the combination of a leadless pacemaker and a ventricular assist device (VAD) is rare. We demonstrated the efficacy of a leadless pacemaker for a subpulmonary left ventricle in a patient with systemic right ventricle on VAD. This approach could be an option even for ACHD patients.
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Affiliation(s)
- Kohsaku Goto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsura Soma
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukiteru Nakayama
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Center for Epidemiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Ando
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasutaka Hirata
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Medical Center for Heart Failure, The University of Tokyo Hospital, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiovascular Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- International University of Health and Welfare, Tokyo, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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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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Bassareo PP, Walsh KP. Micra pacemaker in adult congenital heart disease patients: a case series. J Cardiovasc Electrophysiol 2022; 33:2335-2343. [PMID: 36041216 DOI: 10.1111/jce.15664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/05/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION implantation of transvenous endocardial or epicardial pacemakers presents specific challenges in adult congenital heart disease (ACHD) patients. Micra leadless pacemaker (Micra PPM) may overcome some of these difficulties. METHODS 15 ACHD patients who underwent Micra PPM insertion were retrospectively evaluated. RESULTS males 53.3%. Mean age at study: 37.5±10.7 years. Mean age at Micra PPM insertion: 35.5±11.0 years. Mean follow-up so far: 2.0±0.3 years. Concerning the ACHD patients, 6.7% had a simple defect, 66.6% had a moderately complex defect, 26.7% were complex. Four patients (26.7%) had a previous PPM implantation. Three patients (20%) had a systemic right ventricle. Two patients (13.3%) had a single ventricle physiology. Five (33.3%) had Trisomy 21. The most commonly used Micra PPM modality was VVI (73.3%). Mean threshold post implantation was 0.48 V [range: 0.25-1.13 V], while mean threshold at 6 months control was 0.60 V [range: 0.38-1.13 V] (p=ns). Mean R wave post implantation was 10.3 V [range: 3.25-19.4 V], whilst mean R wave at 6 months follow-up was 10.1 V [range:3.5-19.0 V] (p=ns). No major peri and post-procedural complications were encountered. CONCLUSIONS since ACHD patients are living longer and surviving into adulthood, the incidence of conduction disorders continues to increase, as part of the natural history of some lesions or as early or late complication of surgery. The Micra leadless PPM can be successfully implanted in ACHD patients and have significant theoretical advantages. They should be considered when transvenous and epicardial pacing are either contraindicated or represent an otherwise suboptimal approach. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pier Paolo Bassareo
- University College of Dublin, School of Medicine, National Adult Congenital Heart Disease Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kevin Patrick Walsh
- University College of Dublin, School of Medicine, National Adult Congenital Heart Disease Service, Mater Misericordiae University Hospital, Dublin, Ireland
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Trolese L, Dall’Aglio PB, Faber T, Steinfurt J, Jäckel M, Hilgendorf I. First reported implantation of a VDD leadless pacemaker and a subcutaneus defibrillator in a patient with congenitally corrected transposition of the great arteries. HeartRhythm Case Rep 2022; 8:505-508. [PMID: 35860778 PMCID: PMC9289051 DOI: 10.1016/j.hrcr.2022.04.013] [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: 12/02/2022] Open
Affiliation(s)
- Luca Trolese
- Department of Cardiology and Angiology I, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Rhythmology, Ortenau Klinikum, Offenburg and Lahr, Germany
- Address reprint requests and correspondence: Dr Luca Trolese, University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I, 55 Hugstetter St, 79106 Freiburg, Germany.
| | - Pietro Bernardo Dall’Aglio
- Department of Cardiology and Angiology I, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Faber
- Department of Cardiology and Angiology I, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Steinfurt
- Department of Cardiology and Angiology I, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Jäckel
- Department of Cardiology and Angiology I, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology I, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kautzner J, Wunschova H, Haskova J. Leadless pacemaker implant guided by intracardiac echocardiography in a patient after Mustard repair. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:571-573. [PMID: 34850401 DOI: 10.1111/pace.14417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
This case report describes a successful leadless pacemaker implant (Micra VR Medtronic, Inc, Minneapolis, MN) in a 48-year-old patient with a history of Mustard repair. Twenty-one years after dual-chamber pacemaker implant, both conventional leads became dysfunctional. Lead extraction was refused by the patient and the subclavian vein was obstructed. A leadless pacemaker was selected as an alternative. Intracardiac echocardiography allowed the safe introduction of the delivery system into the non-systemic left ventricle. Four months after implant, the pacing parameters are stable and the patient is without new complaints. A leadless pacemaker could be considered in patients with complex grown-up congenital heart disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hanka Wunschova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Haskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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