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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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Tam MTK, Cheng YW, Chan JYS, Chan CP, Au ACK, Fan KWS, Chim TMY, Kwok WY, Fong FK, Lai A, Tan GM, Yan BP. Aveir VR real-world performance and chronic pacing threshold prediction using mapping and fixation electrical data. Europace 2024; 26:euae051. [PMID: 38457487 PMCID: PMC10923508 DOI: 10.1093/europace/euae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/14/2024] [Indexed: 03/10/2024] Open
Abstract
AIMS Aveir VR performance and predictors for its pacing threshold (PCT) in a real-world cohort were investigated. METHODS Electrical measurements at various stages of an Aveir VR implant were prospectively collected. Predictors for 3-month PCT were studied. A retrospective cohort of consecutive 139 Micra implants was used to compare the PCT evolution. High PCT was defined as ≥1.5 V, using a pulse width of 0.4 ms for Aveir and 0.24 ms for Micra. Excellent PCT was defined as ≤0.5 V at the respective pulse width. RESULTS Among the 123 consecutive Aveir VR implant attempts, 122 (99.2%) were successful. The majority were of advanced age (mean 79.7) and small body size (mean BSA 1.60). Two patients (1.6%) experienced complications, including one pericardial effusion after device reposition and one intraoperative device dislodgement. Eighty-eight patients reached a 3-month follow-up. Aveir 3-month PCT was correlated with impedance at mapping (P = 0.015), tether mode (P < 0.001), end-of-procedure (P < 0.001), and mapping PCT (P = 0.035), but not with PCTs after fixation (P > 0.05). Tether mode impedance >470 ohms had 88% sensitivity and 71% specificity in predicting excellent 3-month PCT. Although it is more common for Aveir to have high PCT at end of procedure (11.5% for Aveir and 2.2% for Micra, P = 0.004), the rate at 3 months was similar (2.3% for Aveir and 3.1% for Micra, P = 1.000). CONCLUSION Aveir VR demonstrated satisfactory performance in this high-risk cohort. Pacing thresholds tend to improve to a greater extent than Micra after implantation. The PCT after fixation, even after a waiting period, has limited predictive value for the chronic threshold. Low-mapping PCT and high intraoperative impedance predict chronic low PCT.
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Affiliation(s)
- Mark T K Tam
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Yuet-Wong Cheng
- Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, KLN, Hong Kong
| | - Joseph Y S Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong
| | - Chin-Pang Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong
| | - Alex C K Au
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong
| | - Katie W S Fan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong
| | - Thomas M Y Chim
- Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, KLN, Hong Kong
| | - Wan-Ying Kwok
- Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, KLN, Hong Kong
| | - Fuk-Kei Fong
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong
| | - Angel Lai
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Guang-Ming Tan
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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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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Lenormand T, Abou Khalil K, Bodin A, Babuty D, Bisson A, Clementy N. Comparison of first- and second-generation leadless pacemakers in patients with sinus rhythm and complete atrioventricular block. J Cardiovasc Electrophysiol 2023; 34:1730-1737. [PMID: 37354448 DOI: 10.1111/jce.15981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The efficacy and safety of leadless cardiac pacemakers (LPMs) as an alternative to conventional transvenous cardiac pacing have been largely reported. The first generation of the MicraTM transcatheter pacing system (VR; Medtronic) was able to provide single-chamber VVI(R) pacing mode only, with a potential risk of pacemaker syndrome in sinus rhythm patients. A second-generation system (AV) now provides atrioventricular synchrony through atrial mechanical (Am) sensing capability (VDD mode). OBJECTIVE We sought to compare VR and AV systems in sinus rhythm patients with chronic ventricular pacing (Vp) for complete atrioventricular block. METHODS All consecutive patients implanted with an LPM in our department for complete atrioventricular block were retrospectively screened. Patients with atrial fibrillation, sinus dysfunction, or Vp burden <20% at 1 month postimplantation were excluded. Patients were systematically followed with a visit at 1 month, and then at least once a year. RESULTS A total of 93 patients-45 VR (2015-2020) and 48 AV (2020-2021)-were included. VR and AV patients had similar baseline characteristics, except for VR patients being older (80 ± 8 vs. 77 ± 9 years, p = 0.049). The mean Vp burden was 77% in the VR and 82% in the AV group (p = 0.38). In AV patients, the median AV synchronous beats rate was 78%, with 65% having a >66% rate. An E/A ratio <1.2 as measured on echocardiography was the only independent predictor of accurate atrial mechanical tracking (p = 0.01). One-year survival rate was similar in both groups. Five patients in the VR and 0 in the AV group eventually developed pacemaker syndrome within 1 year post-implantation (p = 0.02). CONCLUSION In sinus rhythm patients with chronic Vp for complete atrioventricular block implanted with an LPM, the atrial mechanical sensing algorithm allowed significant atrioventricular synchrony in most patients and was associated with no occurrence of-otherwise rare-pacemaker syndrome.
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Affiliation(s)
| | | | - Alexandre Bodin
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Dominique Babuty
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Arnaud Bisson
- Department of Cardiology, University Hospital of Tours, Tours, France
- Department of Cardiology, Hospital Center of Orléans, Orléans, France
| | - Nicolas Clementy
- Cardiology Department, Clinique du Millénaire, Montpellier, France
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Breeman KTN, Oosterwerff EFJ, de Graaf MA, Juffer A, Saleem-Talib S, Maass AH, Wilde AAM, Boersma LVA, Ramanna H, van Dijk VF, van Erven L, Delnoy PPHM, Tjong FVY, Knops RE. Five-year safety and efficacy of leadless pacemakers in a Dutch cohort. Heart Rhythm 2023:S1547-5271(23)02322-6. [PMID: 37271354 DOI: 10.1016/j.hrthm.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Adequate real-world safety and efficacy of leadless pacemakers (LPs) has been demonstrated up to three years after implantation. Longer-term data is warranted to assess the net clinical benefit of leadless pacing. OBJECTIVE To evaluate the long-term safety and efficacy of LP therapy in a real-world cohort. METHODS In this retrospective cohort study, all consecutive patients were included with a first LP implantation from December 21, 2012 to December 13, 2016 in six Dutch high-volume centers. The primary safety endpoint was the rate of major procedure- or device-related complications (i.e., requiring surgery) at five-year follow-up. Analyses were performed with and without Nanostim battery advisory-related complications. The primary efficacy endpoint was the percentage of patients with a pacing capture threshold of ≤2.0V at implantation and without ≥1.5V increase at the last follow-up visit. RESULTS 179 patients were included (mean age 79±9 years), 93 (52%) with a Nanostim and 86 (48%) with a Micra VR LP. Mean follow-up duration was 44±26 months. Forty-one major complications occurred, of which seven not advisory-related. The five-year major complication rate was 4% without advisory-related complications and 27% including advisory-related complications. Not advisory-related major complications occurred median 10 days (range 0-88 days) post-implantation. The pacing capture threshold was low in 163/167 (98%) and stable in 157/160 (98%). CONCLUSION The long-term major complication rate without advisory-related complications was low with LPs. No complications occurred after the acute phase and no infections occurred, which may be a specific benefit of LPs. The performance was adequate with a stable pacing capture threshold.
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Affiliation(s)
- Karel T N Breeman
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands.
| | - Erik F J Oosterwerff
- Isala Clinics, Department of Cardiology, Zwolle, The Netherlands; Flevo Hospital, Department of Cardiology, Almere, The Netherlands
| | - Michiel A de Graaf
- Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
| | - Albert Juffer
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | | | - Alexander H Maass
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - Arthur A M Wilde
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Lucas V A Boersma
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands; St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - Hemanth Ramanna
- Haga Teaching Hospital, Department of Cardiology, the Hague, The Netherlands
| | - Vincent F van Dijk
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - Lieselot van Erven
- Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
| | | | - Fleur V Y Tjong
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
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Lenormand T, Abou Khalil K, Bodin A, Babuty D, Bisson A, Clementy N. Leadless cardiac pacing: Results from a large single-centre experience. Arch Cardiovasc Dis 2023; 116:316-323. [PMID: 37236828 DOI: 10.1016/j.acvd.2023.04.007] [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: 12/05/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The efficacy and safety of leadless cardiac pacing as an alternative to conventional transvenous cardiac pacing in selected patients have been widely reported. AIM To report the experience of a high-volume implantation centre with older and new generations of leadless pacemakers. METHODS This retrospective observational study included the first consecutive 400 patients who underwent implantation of a leadless pacemaker in our centre. Complications and electrical parameters were evaluated during follow-up, comparing patients implanted with first-generation (Micra™ VR) and second-generation (Micra™ AV) leadless pacemakers (Medtronic, Minneapolis, MN, USA). Data were collected by a review of medical files. RESULTS Among 400 procedures, there were 328 Micra™ VR pacemakers and 72 Micra™ AV pacemakers implanted, followed for a median of 16 months (694 patient-years). The mean age was 77 years and both groups had a high burden of co-morbidities. Implantation success rate was 99.5%. A total of 87.5% of patients were discharged the day after the procedure. The pacing threshold remained stable and<2V in 96.5% of all patients. The perioperative complication rate at 30 days was 3.5%. Outcomes were similar between the two groups. CONCLUSION Leadless cardiac pacing is a safe and efficient alternative to conventional transvenous cardiac pacing.
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Affiliation(s)
- Thibault Lenormand
- Department of Cardiology, Tours University Hospital, 37000 Tours, France.
| | - Kassem Abou Khalil
- Department of Cardiology, Tours University Hospital, 37000 Tours, France
| | - Alexandre Bodin
- Department of Cardiology, Tours University Hospital, 37000 Tours, France
| | - Dominique Babuty
- Department of Cardiology, Tours University Hospital, 37000 Tours, France
| | - Arnaud Bisson
- Department of Cardiology, Tours University Hospital, 37000 Tours, France; Department of Cardiology, Orléans Hospital Centre, 45000 Orléans, France
| | - Nicolas Clementy
- Cardiology Department, Clinique du Millénaire, 34000 Montpellier, France
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Wijesuriya N, De Vere F, Mehta V, Niederer S, Rinaldi CA, Behar JM. Leadless Pacing: Therapy, Challenges and Novelties. Arrhythm Electrophysiol Rev 2023; 12:e09. [PMID: 37427300 PMCID: PMC10326662 DOI: 10.15420/aer.2022.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/15/2023] [Indexed: 07/11/2023] Open
Abstract
Leadless pacing is a rapidly growing field. Initially designed to provide right ventricular pacing for those who were contraindicated for conventional devices, the technology is growing to explore the potential benefit of avoiding long-term transvenous leads in any patient who requires pacing. In this review, we first examine the safety and performance of leadless pacing devices. We then review the evidence for their use in special populations, such as patients with high risk of device infection, patients on haemodialysis, and patients with vasovagal syncope who represent a younger population who may wish to avoid transvenous pacing. We also summarise the evidence for leadless cardiac resynchronisation therapy and conduction system pacing and discuss the challenges of managing issues, such as system revisions, end of battery life and extractions. Finally, we discuss future directions in the field, such as completely leadless cardiac resynchronisation therapy-defibrillator devices and whether leadless pacing has the potential to become a first-line therapy in the near future.
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Affiliation(s)
- Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Felicity De Vere
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan M Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Mitacchione G, Schiavone M, Gasperetti A, Arabia G, Breitenstein A, Cerini M, Palmisano P, Montemerlo E, Ziacchi M, Gulletta S, Salghetti F, Russo G, Monaco C, Mazzone P, Hofer D, Tundo F, Rovaris G, Russo AD, Biffi M, Pisanò ECL, Chierchia GB, Della Bella P, de Asmundis C, Saguner AM, Tondo C, Forleo GB, Curnis A. Outcomes of leadless pacemaker implantation following transvenous lead extraction in high-volume referral centers: Real-world data from a large international registry. Heart Rhythm 2023; 20:395-404. [PMID: 36496135 DOI: 10.1016/j.hrthm.2022.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data on the real-world safety and efficacy of leadless pacemakers (LPMs) post-transvenous lead extraction (TLE) are available. OBJECTIVE The purpose of this study was to assess the long-term safety and effectiveness of LPMs following TLE in comparison with LPMs de novo implantation. METHODS Consecutive patients who underwent LPM implantation in 12 European centers joining the International LEAdless PacemakEr Registry were enrolled. The primary end point was the comparison of LPM-related complication rate at implantation and during follow-up (FU) between groups. Differences in electrical performance were deemed secondary outcomes. RESULTS Of the 1179 patients enrolled, 15.6% underwent a previous TLE. During a median FU of 33 (interquartile range 24-47) months, LPM-related major complications and all-cause mortality did not differ between groups (TLE group: 1.6% and 5.4% vs de novo group: 2.2% and 7.8%; P = .785 and P = .288, respectively). Pacing threshold (PT) was higher in the TLE group at implantation and during FU, with very high PT (>2 V@0.24 ms) patients being more represented than in the de novo implantation group (5.4% vs 1.6 %; P = .004). When the LPM was deployed at a different right ventricular (RV) location than the one where the previous transvenous RV lead was extracted, a lower proportion of high PT (>1-2 V@0.24 ms) patients at implantation, 1-month FU, and 12-month FU (5.9% vs 18.2%, P = .012; 3.4% vs 12.9%, P = .026; and 4.3% vs 14.5%, P = .037, respectively) was found. CONCLUSION LPMs showed a satisfactory safety and efficacy profile after TLE. Better electrical parameters were obtained when LPMs were implanted at a different RV location than the one where the previous transvenous RV lead was extracted.
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Affiliation(s)
- Gianfranco Mitacchione
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy; Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy.
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Manuel Cerini
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | | | - Matteo Ziacchi
- Department of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Francesca Salghetti
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Giulia Russo
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi," Lecce, Italy
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patrizio Mazzone
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Tundo
- Heart Rhythm Center, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona, Italy
| | - Mauro Biffi
- Department of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi," Lecce, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Tondo
- Heart Rhythm Center, IRCCS Centro Cardiologico Monzino, Milan, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
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9
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Frazer M, Phan F, Dalouk K, Zarraga IG, Raitt M, Jessel PM. A Case of Leadless-to-Leadless Pacemaker Interaction. HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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10
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El-Chami MF, Shah AD. How to implant leadless pacemakers and mitigate major complications. Heart Rhythm 2023; 20:754-759. [PMID: 36717008 DOI: 10.1016/j.hrthm.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Affiliation(s)
- Mikhael F El-Chami
- Section of Electrophysiology, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Anand D Shah
- Section of Electrophysiology, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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11
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Gulletta S, Schiavone M, Gasperetti A, Breitenstein A, Palmisano P, Mitacchione G, Chierchia GB, Montemerlo E, Statuto G, Russo G, Casella M, Vitali F, Mazzone P, Hofer D, Arabia G, Moltrasio M, Lipartiti F, Fierro N, Bertini M, Dello Russo A, Pisanò ECL, Biffi M, Rovaris G, de Asmundis C, Tondo C, Curnis A, Della Bella P, Saguner AM, Forleo GB. Peri-procedural and mid-term follow-up age-related differences in leadless pacemaker implantation: Insights from a multicenter European registry. Int J Cardiol 2023; 371:197-203. [PMID: 36115442 DOI: 10.1016/j.ijcard.2022.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Age-related differences on leadless pacemaker (LP) are poorly described. Aim of this study was to compare clinical indications, periprocedural and mid-term device-associated outcomes in a large real-world cohort of LP patients, stratified by age at implantation. METHODS Two cohorts of younger and older patients (≤50 and > 50 years old) were retrieved from the iLEAPER registry. The primary outcome was to compare the underlying indication why a LP was preferred over a transvenous PM across the two cohorts. Rates of peri-procedural and mid-term follow-up major complications as well as LP electrical performance were deemed secondary outcomes. RESULTS 1154 patients were enrolled, with younger patients representing 6.2% of the entire cohort. Infective and vascular concerns were the most frequent characteristics that led to a LP implantation in the older cohort (45.8% vs 67.7%, p < 0.001; 4.2% vs 16.4%, p = 0.006), while patient preference was the leading cause to choose a LP in the younger (47.2% vs 5.6%, p < 0.001). Median overall procedural (52 [40-70] vs 50 [40-65] mins) and fluoroscopy time were similar in both groups. 4.3% of patients experienced periprocedural complications, without differences among groups. Threshold values were higher in the younger, both at discharge and at last follow-up (0.63 [0.5-0.9] vs 0.5 [0.38-0-7] V, p = 0.004). CONCLUSION When considering LP indications, patient preference was more common in younger, while infective and vascular concerns were more frequent in the older cohort. Rates of device-related complications did not differ significantly. Younger patients tended to have a slightly higher pacing threshold at mid-term follow-up.
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Affiliation(s)
- Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Milan, IT, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, IT, Italy
| | - Alessio Gasperetti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy.
| | | | | | - Gianfranco Mitacchione
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, IT, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | | | - Giovanni Statuto
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, IT, Italy
| | - Giulia Russo
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi", Lecce, IT, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, IT, Italy
| | - Francesco Vitali
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, IT, Italy
| | - Patrizio Mazzone
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Daniel Hofer
- University Hospital Zurich, Zurich, CH, Switzerland
| | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, IT, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy
| | - Felicia Lipartiti
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | - Nicolai Fierro
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, IT, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, IT, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi", Lecce, IT, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, IT, Italy
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, IT, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, IT, Italy
| | | | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
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12
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Morita J, Kondo Y, Okada T, Kitai T, Kasai Y, Fujita T. Predictors of Pacing Capture Threshold Exacerbation After Leadless Pacemaker Implantation. Int Heart J 2023; 64:602-605. [PMID: 37518341 DOI: 10.1536/ihj.22-698] [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] [Indexed: 08/01/2023]
Abstract
The predictors of pacing capture threshold (PCT) exacerbation after leadless pacemaker implantation remain unknown. We analyzed the predictors of poor PCT by identifying risk factors using multivariate logistic regression analysis for 211 patients with leadless pacemaker implantation. Twenty patients met the criteria for elevated PCT levels and were categorized in the poor PCT group. Multivariate analyses revealed that PCT (P < 0.0001) and pacing impedance (P = 0.03) were independent predictors of PCT exacerbation. Elevated PCT levels and low pacing impedance during leadless pacemaker implantation were potential risk factors for the replacement of leadless pacemakers after the procedure.
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Affiliation(s)
- Junji Morita
- Department of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardiovascular Clinic
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Takuya Okada
- Department of Clinical Engineering, Sapporo Heart Center, Sapporo Cardiovascular Clinic
| | - Takayuki Kitai
- Department of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardiovascular Clinic
| | - Yuhei Kasai
- Department of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardiovascular Clinic
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardiovascular Clinic
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13
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Leadless Pacemaker Implantation in the Emergency Bradyarrhythmia Setting: Results from a Multicenter European Registry. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010067. [PMID: 36676690 PMCID: PMC9861740 DOI: 10.3390/medicina59010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
Background. Data on leadless pacemaker (LPM) implantation in an emergency setting are currently lacking. Objective. We aimed to investigate the feasibility of LPM implantation for emergency bradyarrhythmia, in patients referred for urgent PM implantation, in a large, multicenter, real-world cohort of LPM recipients. Methods. Two cohorts of LPM patients, stratified according to the LPM implantation scenario (patients admitted from the emergency department (ED+) vs. elective patients (ED−)) were retrieved from the iLEAPER registry. The primary outcome of the study was a comparison of the peri-procedural complications between the groups. The rates of peri-procedural characteristics (overall procedural and fluoroscopic duration) were deemed secondary outcomes. Results. A total of 1154 patients were enrolled in this project, with patients implanted due to an urgent bradyarrhythmia (ED+) representing 6.2% of the entire cohort. Slow atrial fibrillation and complete + advanced atrioventricular blocks were more frequent in the ED+ cohort (76.3% for ED+ vs. 49.7% for ED−, p = 0.025; 37.5% vs. 27.3%, p = 0.027, respectively). The overall procedural times were longer in the ED+ cohort (60 (45−80) mins vs. 50 (40−65) mins, p < 0.001), showing higher rates of temporary pacing (94.4% for ED+ vs. 28.9% for ED−, p < 0.001). Emergency LPM implantation was not correlated with an increase in the rate of major complications compared to the control group (6.9% ED+ vs. 4.2% ED−, p = 0.244). Conclusion. LPM implantation is a feasible procedure for the treatment of severe bradyarrhythmia in an urgent setting. Urgent LPM implantation was not correlated with an increase in the rate of major complications compared to the control group, but it was associated with longer procedural times.
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14
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Almas T, Haider R, Malik J, Mehmood A, Alvi A, Naz H, Satti DI, Zaidi SMJ, AlSubai AK, AlNajdi S, Alsufyani R, Ramtohul RK, Almesri A, Alsufyani M, H. Al-Bunnia A, Alghamdi HAS, Sattar Y, Alraies MC, Raina S. Nanotechnology in interventional cardiology: A state-of-the-art review. IJC HEART & VASCULATURE 2022; 43:101149. [DOI: 10.1016/j.ijcha.2022.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
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15
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Togashi I, Sato T, Akiko Maeda NP, Mohri T, Katsume Y, Tashiro M, Momose Y, Nonoguchi N, Hoshida K, Miwa Y, Ueda A, Soejima K. Fluoroscopic Predictors of Acceptable Capture threshold during the Implantation of the Micra Transcatheter Pacing System. J Cardiovasc Electrophysiol 2022; 33:1255-1261. [PMID: 35304791 PMCID: PMC9315022 DOI: 10.1111/jce.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Introduction Few predictors of low capture threshold before the deployment of the Micra transcatheter pacing system (Micra TPS) have been determined. We aimed to identify fluoroscopic predictors of an acceptable capture threshold before Micra TPS deployment. Methods Sixty patients were successfully implanted with Micra TPS. Before deployment, gooseneck appearance of the catheter shaft was quantified using the angle between the tangent line of the shaft and the cup during diastole in the right anterior oblique (RAO) view. The direction of the device cup toward the ventricular septum was evaluated using the angle between the cup and the horizontal plane in the left anterior oblique (LAO) view. Results Of the 95 deployments we evaluated, 56 achieved an acceptable capture threshold of ≤2.0 V at 0.24 ms. In this acceptable threshold group, the deflection angle of the gooseneck shaft was significantly larger and the device cup was placed more horizontally with a lower elevation angle compared with those in the high threshold group. A deflection angle of ≥6° and an elevation angle of ≤30° were identified as the predictors of an acceptable capture threshold after deployment. An acceptable capture threshold was achieved in 24/31 (77.4%) patients in whom either angle criterion was satisfied at the first deployment. Conclusions Diastolic gooseneck appearance of the delivery catheter in the RAO view or near‐horizontal direction in the LAO view predicts an acceptable capture threshold after deployment. The shape of the delivery catheter before deployment should be evaluated using multiple fluoroscopic views to ensure successful implantation of Micra TPS.
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Affiliation(s)
- Ikuko Togashi
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka, Japan
| | - Toshiaki Sato
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka, Japan
| | - N P Akiko Maeda
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Takato Mohri
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yumi Katsume
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Mika Tashiro
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yuichi Momose
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Noriko Nonoguchi
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Hoshida
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yosuke Miwa
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Soejima
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
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16
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Hiramatsu T, Mizutani Y, Yanagisawa S, Sugiyama T, Yamashita D, Tajima A, Yonekawa J, Makino Y, Suzuki H, Ichimiya H, Uchida Y, Watanabe J, Kanashiro M, Inden Y, Murohara T. Usefulness of the Snare Technique During Leadless Pacemaker Implantation for a Patient with a Severely Dilated Right Atrium. Int Heart J 2022; 63:159-162. [DOI: 10.1536/ihj.21-499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | - Atomu Tajima
- Department of Cardiology, Yokkaichi Municipal Hospital
| | - Jun Yonekawa
- Department of Cardiology, Yokkaichi Municipal Hospital
| | | | - Hitomi Suzuki
- Department of Cardiology, Yokkaichi Municipal Hospital
| | | | | | | | | | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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17
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Piccini JP, Cunnane R, Steffel J, El-Chami MF, Reynolds D, Roberts PR, Soejima K, Steinwender C, Garweg C, Chinitz L, Ellis CR, Stromberg K, Fagan DH, Mont L. Development and validation of a risk score for predicting pericardial effusion in patients undergoing leadless pacemaker implantation: experience with the Micra transcatheter pacemaker. Europace 2022; 24:1119-1126. [PMID: 35025987 PMCID: PMC9301971 DOI: 10.1093/europace/euab315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS There is limited information on what clinical factors are associated with the development of pericardial effusion after leadless pacemaker implantation. We sought to determine predictors of and to develop a risk score for pericardial effusion in patients undergoing Micra leadless pacemaker implantation attempt. METHODS AND RESULTS Patients (n = 2817) undergoing implant attempt from the Micra global trials were analysed. Characteristics were compared between patients with and without pericardial effusion (including cardiac perforation and tamponade). A risk score for pericardial effusion was developed from 18 pre-procedural clinical variables using lasso logistic regression. Internal validation and future prediction performance were estimated using bootstrap resampling. The scoring system was also externally validated using data from the Micra Acute Performance European and Middle East (MAP EMEA) registry. There were 32 patients with a pericardial effusion [1.1%, 95% confidence interval (CI): 0.8-1.6%]. Following lasso logistic regression, 11 of 18 variables remained in the model from which point values were assigned. The C-index was 0.79 (95% CI: 0.71-0.88). Patient risk score profile ranged from -4 (lowest risk) to 5 (highest risk) with 71.8% patients considered low risk (risk score ≤0), 16.6% considered medium risk (risk score = 1), and 11.7% considered high risk (risk score ≥2) for effusion. The median C-index following bootstrap validation was 0.73 (interquartile range: 0.70-0.75). The C-index based on 9 pericardial effusions from the 928 patients in the MAP EMEA registry was 0.68 (95% CI: 0.52-0.83). The pericardial effusion rate increased significantly with additional Micra deployments in medium-risk (P = 0.034) and high-risk (P < 0.001) patients. CONCLUSION The overall rate of pericardial effusion following Micra implantation attempt is 1.1% and has decreased over time. The risk of pericardial effusion after Micra implant attempt can be predicted using pre-procedural clinical characteristics with reasonable discrimination. CLINICAL TRIAL REGISTRATION The Micra Post-Approval Registry (ClinicalTrials.gov identifier: NCT02536118), Micra Continued Access Study (ClinicalTrials.gov identifier: NCT02488681), and Micra Transcatheter Pacing Study (ClinicalTrials.gov identifier: NCT02004873).
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Affiliation(s)
- Jonathan P Piccini
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC 27710, USA
| | | | - Jan Steffel
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | | | - Dwight Reynolds
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Clemens Steinwender
- Kepler University Hospital, Linz, Austria.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | - Christopher R Ellis
- Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
| | | | | | - Lluis Mont
- Institut Clinic Cardiovascular (ICCV), Hospital Clinic, Universitat de Barcelona, Institut per la Recera Biomèdica IDIBAPS, Catalonia, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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18
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Mitacchione G, Arabia G, Schiavone M, Cerini M, Gasperetti A, Salghetti F, Bontempi L, Viecca M, Curnis A, Forleo GB. Intraoperative sensing increase predicts long-term pacing threshold in leadless pacemakers. J Interv Card Electrophysiol 2022; 63:679-686. [PMID: 34981291 DOI: 10.1007/s10840-021-01111-x] [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: 08/18/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE High pacing threshold (HPT) and very high pacing threshold (VHPT) are known to have a negative impact on leadless pacemaker battery longevity, representing the most common reason for device repositioning. In this study, we evaluated if intraoperative electrical parameters recorded during Micra™ VR implant would be able to predict device performance during follow-up (FU). METHODS A total of 93 patients undergoing Micra™ VR implant were retrospectively considered. Patients were enrolled in the study if electrical assessment was performed at least twice at implant, at Micra™ final positioning and after removal of the delivery system. All patients received a FU visit at 1 and 12 month after discharge. R-wave sensing amplitude, pacing threshold (PT), and impedance were recorded at each visit. RESULTS When compared to the first assessment, R-wave sensing amplitude increased by 19.1% after 13 ± 4 min (+ 1.71 ± 0.2 mV, 95% CI 1.4 to 2.02; p < .001). Conversely, there was a significant PT decrease of 22.1% at 12-month FU (- 0.22 ± 0.03 V, 95% CI - 0.13 to - 0.31; p < .001). Among patients with HPT, acute increase of R-wave sensing of 1.5 mV after 14 ± 4 min predicted a significant reduction of PT below 1 V/0.24, at 12-month post-implant (R = 0.72, 95% CI 0.13 to 0.33, p < .001), with a sensitivity of 87.5% (95% CI 0.61-0.98) and a specificity of 88.8% (95% CI 0.51-0.99). CONCLUSION A 1.5-mV increase in R-wave amplitude at implant is predictive of PT normalization (< 1.0 V/0.24 ms) at 12-month FU. This finding may have practical implications for device repositioning in case of HPT recording at implant.
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Affiliation(s)
- Gianfranco Mitacchione
- Department of Cardiology, Luigi Sacco - University Hospital, Via G.B. Grassi 74. 20157, Milan, Italy.
| | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco - University Hospital, Via G.B. Grassi 74. 20157, Milan, Italy
| | - Manuel Cerini
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Alessio Gasperetti
- Department of Cardiology, Luigi Sacco - University Hospital, Via G.B. Grassi 74. 20157, Milan, Italy
| | - Francesca Salghetti
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Luca Bontempi
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Maurizio Viecca
- Department of Cardiology, Luigi Sacco - University Hospital, Via G.B. Grassi 74. 20157, Milan, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco - University Hospital, Via G.B. Grassi 74. 20157, Milan, Italy
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Arai H, Mizukami A, Hanyu Y, Kawakami T, Shimizu Y, Hiroki J, Yoshioka K, Ohtani H, Ono M, Yamashita S, Iwatsuka R, Ueshima D, Matsumura A, Goya M, Sasano T. Leadless pacemaker implantation sites confirmed by computed tomography and their parameters and complication rates. Pacing Clin Electrophysiol 2022; 45:196-203. [PMID: 34981524 DOI: 10.1111/pace.14437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/21/2021] [Accepted: 12/26/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Implantations of leadless pacemakers in the septum lower the risk of cardiac perforation. However, the relationship between the implantation site and the success rate, complication rate, and pacemaker parameters are not well-investigated. METHODS Patients who underwent leadless pacemaker implantation with postprocedural computed tomography (CT) between September 2017 and November 2020 were analyzed. Septum was targeted with fluoroscopic guidance with contrast injection. We divided patients into two groups based on the implantation site confirmed by CT: septal and non-septal, which included the anterior/posterior edge of the septum and free wall. We compared the complication rates and pacemaker parameters between the two groups. RESULTS A total of 67 patients underwent CT after the procedure; among them, 28 were included in the septal group and 39 were included in the non-septal group. The non-septal group had significantly higher R wave amplitudes (6.5 ± 3.3 vs. 9.7 ± 3.9 mV, p = .001), lower pacing threshold (1.0 ± 0.94 vs. 0.63 ± 0.45 V/0.24 ms, p = .02), and higher pacing impedance (615 ± 114.1 vs. 712.8 ± 181.3 ohms, p = .014) after the procedure compared to the septal group. Cardiac injuries were observed in four patients (one cardiac tamponade, one possible apical hematoma, two asymptomatic pericardial effusion), which were only observed in the non-septal group. CONCLUSIONS Leadless pacemaker implantation may be technically challenging with substantial number of patients with non-septal implantation when assessed by CT. Septal implantation may have a lower risk of cardiac injury but may lead to inferior pacemaker parameters than non-septal implantation.
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Affiliation(s)
- Hirofumi Arai
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Akira Mizukami
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yoshihiro Hanyu
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Takuya Kawakami
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yuki Shimizu
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Jiro Hiroki
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hirofumi Ohtani
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Maki Ono
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Shu Yamashita
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Ryota Iwatsuka
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Daisuke Ueshima
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Akihiko Matsumura
- Department of Cardiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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20
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Rate-dependent change in capture threshold following implantation of a leadless pacemaker. HeartRhythm Case Rep 2021; 8:183-186. [PMID: 35492834 PMCID: PMC9039530 DOI: 10.1016/j.hrcr.2021.12.004] [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: 11/23/2022] Open
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21
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Stazi F. The wireless pacemaker is on again; from electro-stimulation to synchronization. Eur Heart J Suppl 2021; 23:E156-E160. [PMID: 34650377 PMCID: PMC8503492 DOI: 10.1093/eurheartj/suab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leadless stimulation of the right ventricle is now a reality, especially in patients with very specific indications and clinical characteristics, even in the absence of randomized studies to support its use. The reduction of device costs and the refinement of atrioventricular synchronization algorithms will sanction its greater diffusion in the future. The possibility of using leadless technology also for resynchronization therapy, on the other hand, is currently a promising option but, pending randomized studies with robust case histories and adequate follow-ups, it should still be considered as a niche therapy, to be limited to centres highly specialized and in patients in whom conventional resynchronization has been impossible or ineffective.
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Affiliation(s)
- Filippo Stazi
- UOC Cardiologia d'Urgenza, Ospedale San Giovanni Addolorata, Roma
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22
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Aizawa Y, Ichiki T, Yoshizawa A, Monma Y, Nakayama T, Kato TS, Inami S, Fujimoto Y, Kawamura A. Successful Leadless Pacemaker Implantation in an Elderly Patient With Dextrocardia and Situs Inversus. Cureus 2021; 13:e17858. [PMID: 34527500 PMCID: PMC8432435 DOI: 10.7759/cureus.17858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/05/2022] Open
Abstract
Leadless pacemaker is indicated in patients with symptomatic bradycardia as an alternative therapy when transvenous pacemaker implantation is considered difficult or at high risk. The experience of implanting leadless pacemaker in patients with dextrocardia and situs inversus is limited. A 94-year-old male was transferred to our hospital due to advanced atrio-ventricular block with episode of syncope. Chest radiograph and computed tomography revealed dextrocardia with situs inversus. Emergency cardiac catheterization was performed and a temporary pacemaker was inserted, but the patient removed it due to delirium. So, a leadless pacemaker was implanted to him. Shorter time of bed-rest after the implantation and shorter hospital stay would be beneficial of implanting a leadless pacemaker. Precise anatomical evaluation would be important to perform implantation efficiently and safely.
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Affiliation(s)
- Yoshiyasu Aizawa
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Tomoko Ichiki
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Akihiro Yoshizawa
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Yuto Monma
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Takashi Nakayama
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Tomoko S Kato
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Shigenobu Inami
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Yoshihide Fujimoto
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
| | - Akio Kawamura
- Cardiology, International University of Health and Welfare Narita Hospital, Narita, JPN
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23
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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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24
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Kiani S, Wallace K, Stromberg K, Piccini JP, Roberts PR, El-Chami MF, Soejima K, Garweg C, Fagan DH, Lloyd MS. A Predictive Model for the Long-Term Electrical Performance of a Leadless Transcatheter Pacemaker. JACC Clin Electrophysiol 2020; 7:502-512. [PMID: 33358666 DOI: 10.1016/j.jacep.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to formulate a predictive model for describing the long-term electrical performance of Micra (Medtronic, Mounds View, Minnesota). BACKGROUND The Micra leadless pacemaker is an alternative ventricular pacing option that avoids the pitfalls of transvenous leads. However, well-defined metrics to predict the long-term electrical performance of the device are lacking. METHODS We identified all patients who underwent successful Micra implantation enrolled in the investigational device exemption study, continued access study, or post-approval registry with complete 1-year post-implantation data or system revision due to elevated thresholds (N = 1,843). The analysis endpoint was an elevated pacing capture threshold (PCT) at ≥12 months post-implantation, defined as ≥2.0 V at 0.24 ms or an increase of ≥1.5 V from implantation or need for system revision due to elevated thresholds at ≤12 months post-implantation. We evaluated for univariate and multivariate associations between patient and device characteristics at implantation and for elevated thresholds at 12 months. RESULTS Among the total cohort, 75 patients (4.1%) had elevated thresholds at 12 months; of these, 13 required system revisions. Predictors associated with elevated thresholds in univariate analysis included the total number of deployments (excluded from the multivariable model), impedance and PCT at implantation, male sex, history of diabetes, and ischemic cardiomyopathy. Multivariable regression modeling found that male sex, history of diabetes, implantation PCT of ≥2 V, and impedance of <800 Ω were independent predictors of elevated PCT at 12 months (all p < 0.05). CONCLUSION A history of diabetes, male sex, elevated PCT, and low impedance at implantation were independent predictors of elevated thresholds at 12 months. These metrics represent the foundation of a simple tool to aid in procedural decision making.
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Affiliation(s)
- Soroosh Kiani
- Department of Internal Medicine, Division of Cardiology, Section of Cardiac Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA.
| | | | | | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Paul R Roberts
- Southampton General Hospital-University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Mikhael F El-Chami
- Department of Internal Medicine, Division of Cardiology, Section of Cardiac Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Michael S Lloyd
- Department of Internal Medicine, Division of Cardiology, Section of Cardiac Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
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25
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Guleria VS, Sharma P, Bharadwaj P. Accidental Snapping of Right Ventricular Pacing Lead with MICRA. J Saudi Heart Assoc 2020; 32:408-409. [PMID: 33299783 PMCID: PMC7721444 DOI: 10.37616/2212-5043.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022] Open
Abstract
Leadless Pacemaker implantation rates are increasing worldwide. These pacemakers have to be deployed, captured and redeployed in order to achieve optimal electric parameters. Various complications occur during this procedure. We herein report a unique case, where right ventricular (RV) pacing lead of the patient was accidently snapped with the tines during deployment of intracardiac pacemaker in an elderly male with pocket site infection.
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Affiliation(s)
- Vivek S Guleria
- Department of Cardiology, Army Hospital Research & Referral, New Delhi, India
| | - Prafull Sharma
- Department of Cardiology, Army Hospital Research & Referral, New Delhi, India
| | - Prashant Bharadwaj
- Department of Cardiology, Army Hospital Research & Referral, New Delhi, India
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26
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Bhatia NK, Kiani S, Merchant FM, Delurgio DB, Patel AM, Leon AR, Lloyd MS, Westerman SB, Shah AD, El-Chami MF. Life cycle management of Micra transcatheter pacing system: Data from a high-volume center. J Cardiovasc Electrophysiol 2020; 32:484-490. [PMID: 33251698 DOI: 10.1111/jce.14825] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/09/2020] [Accepted: 11/22/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Data on the management of Micra transcatheter pacing system (TPS) at the time of an upgrade or during battery depletion is limited. OBJECTIVE We sought to evaluate the management patterns of patients implanted with a Micra TPS during long-term follow-up. METHODS We retrospectively identified patients who underwent Micra implantation from April 2014 to November 2019. We identified patients who underwent extraction (n = 11) or had an abandoned Micra (n = 12). RESULTS We identified 302 patients who received a Micra during the period of the study. Mean age was 72.7 ± 15.4 years, 54.6% were men, and left ventricular ejection fraction was 51.9 ± 5.2%. Mean follow-up was 1105.5 ± 529.3 days. Procedural complications included pericardial tamponade (n = 1) treated with pericardiocentesis, significant rise in thresholds (n = 6) treated with reimplantation (n = 4), and major groin complications (n = 2). Indications for extraction included an upgrade to cardiac resynchronization therapy (CRT) device (n = 3), bridging after extraction of an infected transvenous system (n = 3), elevated thresholds (n = 3), and non-Micra-related bacteremia (n = 2). The median time from implantation to extraction was 78 days (interquartile range: 14-113 days), with the longest extraction occurring at 1442 days. All extractions were successful, with no procedural or long-term complications. Indications for abandonment included the need for CRT (n = 6), battery depletion (n = 2), increasing thresholds/failure to capture (n = 3), and pacemaker syndrome (n = 1). All procedures were successful, with no procedural or long-term complications. CONCLUSION In this large single-center study, 6% of patients implanted with a Micra required a system modification during long-term follow-up, most commonly due to the requirement for CRT pacing. These patients were managed successfully with extraction or abandonment.
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Affiliation(s)
- Neal K Bhatia
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Soroosh Kiani
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - David B Delurgio
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Anshul M Patel
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Angel R Leon
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Stacy B Westerman
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Anand D Shah
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Mikhael F El-Chami
- Section of Electrophysiology, Division of Cardiology, Emory University, Atlanta, Georgia, USA
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27
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Curnis A, Salghetti F, Cerini M, Fabbricatore D, Ghizzoni G, Arrigoni L, Generati G, Arabia G, Maiolo V, Aboelhassan M, Bontempi L. Leadless pacemaker: State of the art and incoming developments to broaden indications. Pacing Clin Electrophysiol 2020; 43:1428-1437. [DOI: 10.1111/pace.14097] [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: 05/25/2020] [Revised: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Curnis
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Francesca Salghetti
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Manuel Cerini
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Davide Fabbricatore
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Giulia Ghizzoni
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Luca Arrigoni
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Greta Generati
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Gianmarco Arabia
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Vincenzo Maiolo
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | | | - Luca Bontempi
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
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28
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Hai JJ, Chan YH, Lau CP, Tse HF. Single-chamber leadless pacemaker for atrial synchronous or ventricular pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1438-1450. [PMID: 33089883 DOI: 10.1111/pace.14105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/21/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022]
Abstract
Leadless pacing is a major breakthrough in the management of bradyarrhythmia. Results of initial clinical trials that have demonstrated a significant reduction in acute and long-term pacing-related complications have been confirmed by real-world experience in a broader spectrum of patients. Nonetheless current use of a leadless pacemaker is hampered by its limited atrial sensing and pacing capability, as well as battery life-span and retrievability. We review the current clinical outcome data, indications and contraindications, implantation and retrieval techniques, synchronous ventricular pacing, and other clinical considerations. We also provide an overview of the latest advancements in leadless pacing technology including device-to-device communication and energy harvesting technology.
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Affiliation(s)
- Jo-Jo Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.,Division of Cardiology, Department of Medicine, University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Yap-Hang Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China.,Shenzhen Institute of Research and Innovation, University of Hong Kong, Shenzhen, China
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29
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Higuchi M, Shinoda Y, Hasegawa T, Ishibashi M, Yamada N, Chiba Y, Ohira K, Murata M, Aonuma K. Predictors of increase in pacing threshold after transcatheter pacing system implantation due to micro-dislodgement. Pacing Clin Electrophysiol 2020; 43:1351-1357. [PMID: 32969504 DOI: 10.1111/pace.14080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Achieving a favorable pacing threshold with a Micra transcatheter pacing system (Micra-TPS) is needed to reduce battery depletion. In some cases, the threshold increases shortly after the device is implanted, and a higher pacing threshold may be required. This study aims to identify the causes and predictors of the increase in pacing threshold observed shortly after Micra-TPS implantation. METHODS The study included 64 consecutive patients who underwent Micra-TPS implantation between 2017 and 2020. The patients were divided into two groups depending on their pacing threshold: the increased pacing threshold (IPT) group (threshold increased by ≥0.5 V/0.24 ms within 1 month of implantation) and the stable pacing threshold (SPT) group. RESULTS Excluding four patients who could not be followed up, of the 60 remaining patients, nine (15%) were in the IPT group and 51 (85%) were in the SPT group. The IPT group had significantly lower implant impedance values and higher implant thresholds than the SPT group (582 ± 59 vs 755 ± 167 Ω [P < .001] and 1.29 ± 0.87 vs 0.71 ± 0.40 V/0.24 ms [P = .014]). Implant impedance and threshold may serve as predictors of a threshold increase after implantation (area under the curve: 0.737-0.943 and 0.586-0.926, respectively). CONCLUSIONS An IPT was noted shortly after Micra-TPS implantation owing to micro-dislodgement because of insufficient anchoring of the device to the myocardium. Impedance >660 Ω and threshold <1.0 V/0.24 ms may predict an increase in pacing threshold.
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Affiliation(s)
- Motoaki Higuchi
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Yasutoshi Shinoda
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Tomoaki Hasegawa
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Mayu Ishibashi
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Norihiro Yamada
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Koji Ohira
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Minoru Murata
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
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30
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Bongiorni MG, Della Tommasina V, Barletta V, Di Cori A, Rogani S, Viani S, Segreti L, Paperini L, Soldati E, De Lucia R, Zucchelli G. Feasibility and long-term effectiveness of a non-apical Micra pacemaker implantation in a referral centre for lead extraction. Europace 2020; 21:114-120. [PMID: 29893837 DOI: 10.1093/europace/euy116] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/20/2018] [Indexed: 11/12/2022] Open
Abstract
Aims To demonstrate the feasibility and long-term performances of a non-apical Micra pacemaker implantation. Methods and results Fifty-two consecutive patients underwent Micra implantation, targeting a non-apical site of delivery when feasible. Each patient received a regular follow-up (mean 13 ± 9 months). The first 17 patients were also enrolled in the Micra transcatheter pacing system trial (Group 1); the remaining ones presented broader indications and included post-extraction subjects (Group 2). In 19 of 52 patients (Group 1: 6%, Group 2: 51%; P = 0.002) Micra was implanted because of high-risk characteristics that discouraged the implantation of a traditional pacemaker. In 31 of 52 patients (60%) Micra was implanted in a non-apical location, with a lower rate of single delivery compared with apical sites (48% vs. 81%, P = 0.035), but without any impact on electrical performance. Pacing threshold remained optimal in the majority of patients (94%), regardless of the site of implantation (apical vs. non-apical location: 0.50 vs. 0.52 V/0.24 ms; P = 0.856) and group membership, with only 6% of the subjects showing elevated values (mean 1.92 ± 0.92 V/0.24 ms) at the last follow-up. No device-related adverse events were registered. Conclusion Micra pacemaker implant is a safe and effective procedure even in a real life cohort of high-risk patients. A non-apical site of implantation is feasible in the majority of patients allowing stable electrical performance at long-term follow-up.
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Affiliation(s)
- Maria Grazia Bongiorni
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Veronica Della Tommasina
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Valentina Barletta
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Andrea Di Cori
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Sara Rogani
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Stefano Viani
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Luca Segreti
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Luca Paperini
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Ezio Soldati
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Raffaele De Lucia
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
| | - Giulio Zucchelli
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy
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31
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Zucchelli G, Tolve S, Barletta V, Di Cori A, Parollo M, De Lucia R, Della Tommasina V, Giannotti Santoro M, Viani S, Cellamaro T, Segreti L, Paperini L, Soldati E, Bongiorni MG. Comparison between leadless and transvenous single-chamber pacemaker therapy in a referral centre for lead extraction. J Interv Card Electrophysiol 2020; 61:395-404. [DOI: 10.1007/s10840-020-00832-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/17/2020] [Indexed: 01/28/2023]
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32
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Rordorf R, Savastano S, Bontempi L, De Regibus V, Mulargia E, Baldi E, Iacopino S, Lunati MG, Curnis A. Leadless pacing in cardiac transplant recipients: Primary results of a multicenter case experience. J Electrocardiol 2020; 60:33-35. [DOI: 10.1016/j.jelectrocard.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 11/26/2022]
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33
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Kajiyama T, Kondo Y, Nakano M, Miyazawa K, Nakano M, Hayashi T, Ito R, Takahira H, Kitagawa M, Kobayashi Y. Peak deflection index as a predictor of a free-wall implantation of contemporary leadless pacemakers. J Interv Card Electrophysiol 2020; 60:239-245. [PMID: 32242303 DOI: 10.1007/s10840-020-00724-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Leadless pacemakers are an effective treatment for bradycardia. However, some cases exhibit pericardial effusions, presumably associated with device implantations on the right ventricular free-wall. The present study was carried out to find the ECG features during ventricular pacing with a Micra, which enabled distinguishing free-wall implantations from septal implantations without using imaging modalities. METHODS Thirty-one consecutive patients who received Micra implantations in our facility were enrolled. The location of the device in the right ventricle was evaluated using echocardiography or computed tomography in order to determine whether the device was implanted on the septum (Sep group), apex (Apex group), or free-wall (FW group). The differences in the 12-lead ECG during ventricular pacing by the Micra were analyzed between the Sep and FW groups. RESULTS The body of the Micra was clearly identifiable in 22 patients. The location of the device was classified into Sep in 12 patients, Apex in 4, and FW in 6. The mean age was highest in the FW and lowest in the Sep group (82.7 ± 6.6 vs. 72.8 ± 8.7 years, p = 0.027). The peak deflection index (PDI) was significantly larger in the FW group than Sep/Apex group in lead V1 (Sep: 0.505 ± 0.010, Apex: 0.402 ± 0.052, FW: 0.617 ± 0.043, p = 0.004) and lead V2 (Sep: 0.450 ± 0.066, Apex: 0.409 ± 0.037, FW: 0.521 ± 0.030, p = 0.011), whereas there was no difference in the QRS duration, transitional zone, and QRS notching. CONCLUSION The PDI in V1 could be useful for predicting implantations of Micra devices on the free-wall and may potentially stratify the risk of postprocedural pericardial effusions.
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Affiliation(s)
- Takatsugu Kajiyama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yusuke Kondo
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masahiro Nakano
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuo Miyazawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Miyo Nakano
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tomohiko Hayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ryo Ito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Haruhiro Takahira
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Mari Kitagawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Breatnach CR, Dunne L, Al-Alawi K, Oslizlok P, Kenny D, Walsh KP. Leadless Micra Pacemaker Use in the Pediatric Population: Device Implantation and Short-Term Outcomes. Pediatr Cardiol 2020; 41:683-686. [PMID: 31858200 DOI: 10.1007/s00246-019-02277-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Abstract
The development of Leadless cardiac pacemakers avoids the inherent complications that may occur secondary to lead insertion. A large number of devices have been inserted in adult patients although data in pediatric patients are lacking. We aimed to assess our experience with the Leadless device in the pediatric population. We performed a retrospective study on all pediatric patients who underwent insertion of a Leadless pacemaker in our center. Data were collected for demographic, procedural, and outcome variables. Nine patients with a median (IQR) age and weight of 13 (12-14) years and 37 (31-50) kg, respectively, were enrolled. The median (IQR) procedural time was 62 (60-65) min with insertion thresholds of 0.5 (0.35-1) Volts at 0.24 ms. All devices were successfully inserted without complication. One device was replaced with a single-lead endocardial pacemaker at 1 year for increased thresholds. Leadless pacemaker device insertion is feasible in pediatric patients. Further studies and long-term follow-up are needed to ascertain device longevity and complication rates.
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Affiliation(s)
- C R Breatnach
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
| | - L Dunne
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - K Al-Alawi
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - P Oslizlok
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - D Kenny
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - K P Walsh
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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Tolosana JM, Guasch E, San Antonio R, Apolo J, Pujol‐López M, Chipa‐Ccasani F, Trucco E, Roca‐Luque I, Brugada J, Mont L. Very high pacing thresholds during long‐term follow‐up predicted by a combination of implant pacing threshold and impedance in leadless transcatheter pacemakers. J Cardiovasc Electrophysiol 2020; 31:868-874. [DOI: 10.1111/jce.14360] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- José M. Tolosana
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain
| | - Eduard Guasch
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain
| | - Rodolfo San Antonio
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain
| | - Jose Apolo
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
| | - Margarida Pujol‐López
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
| | - Fredy Chipa‐Ccasani
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
| | - Emilce Trucco
- Arrhythmia Section, Department of CardiologyHospital Universitari Doctor Josep Trueta Girona Catalonia Spain
| | - Ivo Roca‐Luque
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
| | - Josep Brugada
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain
| | - Lluís Mont
- Arrhythmia Section, Hospital Clínic, Cardiovascular Clinic InstituteUniversity of Barcelona Barcelona Catalonia Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Catalonia Spain
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Tachibana M, Banba K, Matsumoto K, Ohara M. The feasibility of leadless pacemaker implantation for superelderly patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:374-381. [PMID: 32134134 DOI: 10.1111/pace.13894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The safety and efficacy of the leadless pacemaker (LP) have been confirmed in previous reports, yet studies on LPs in superelderly patients are limited. METHODS AND RESULTS A total of 62 patients aged over 85 years old were implanted with single-chamber pacemakers due to symptomatic bradyarrhythmia at Sakakibara Heart Institute from May 2014 through July 2019. We divided them into two groups, a transvenous (TV) single-chamber pacemaker group (35 patients) and an LP group (27 patients), and compared the groups. Mean participant age was 90.3 ± 3.8 y.o., 41.9% were male, and mean participant body mass index (BMI) was 21.3 kg/m2 . The LP group contained a significantly larger proportion of patients with dementia than the TV group did (63% vs. 37.1%, P = .04). The complication-free rate tended to be lower in the LP group in spite of the higher frequency of dementia (88.6% vs. 92.6%, P = .68). At implantation, the pacing threshold was significantly higher in the LP group than in the TV group (1.30 ± 0.91 V vs. 0.71 ± 0.23 V, P < .01), but over the first 3 months after the operation the pacing threshold in the LP group gradually improved (0.82 ± 0.2 V vs. 1.05 ± 1.02 V, P = .16). The procedure time and time from operation to discharge were also shorter in the LP group. CONCLUSIONS LP implantation appears to be safe and is accordingly becoming the cornerstone for Japanese superelderly patients indicated for single-chamber pacemakers, even for those with small bodies and dementia. However, careful procedures and long follow-ups are needed until a greater volume of data is reported.
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Affiliation(s)
- Motomi Tachibana
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kimikazu Banba
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kensuke Matsumoto
- Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Minako Ohara
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Takamatsu, Kagawa, Japan
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Management of anticoagulation in patients undergoing leadless pacemaker implantation. Heart Rhythm 2019; 16:1849-1854. [DOI: 10.1016/j.hrthm.2019.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Indexed: 11/20/2022]
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Afzal MR, Shah N, Daoud G, Houmsse M. Current state of leadless pacemakers: state of the art review. Expert Rev Cardiovasc Ther 2019; 17:699-706. [DOI: 10.1080/14779072.2019.1664288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Muhammad R. Afzal
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Nupur Shah
- Department of internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Georges Daoud
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
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Yoh M, Takagi M, Takahashi H, Yoshio T, Shiojima I. The unstable pacing thresholds of the leadless transcatheter pacemaker affected by body positions in subacute phase after implant. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:yty160. [PMID: 31020236 PMCID: PMC6439362 DOI: 10.1093/ehjcr/yty160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 11/25/2022]
Abstract
Background If the threshold at implant of leadless transcatheter pacemakers (LTPs) is less than 2.0 V, pacing thresholds reportedly decrease significantly by 1 month and maintain an optimal value of less than 1.0 V by 6 months. Case summary We report a case series of two patients with unstable pacing thresholds of the LTPs in the subacute phase after implant. The first patient (77-year-old man) was implanted an LTP for sick sinus syndrome. At that time of implant, the pacing threshold was 0.9 V at 0.24 ms. At 1 week and 1 month later, the threshold had increased to more than 2.0 V at 0.24 ms. We investigated the trend data for the week and found variations in the threshold. The second patient (81-year-old man) was implanted an LTP for bradycardia and atrial fibrillation. The pacing threshold at implantation was 0.63 V at 0.24 ms. One week later, the threshold had increased in supine position and decreased in sitting position. The trend data for the week were fluctuating greatly. Discussion The pacing threshold may increase to more than 2.0 V with significant fluctuation on assessment at 1 week and 1 month after implantation in association with changes in body position, even though we confirmed a stable threshold at implant. If an increased threshold is observed, it is necessary to check the trend data and threshold in each body position.
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Affiliation(s)
- Masue Yoh
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Japan
| | - Masahiko Takagi
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Japan
| | - Hiroki Takahashi
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Japan
| | - Takuro Yoshio
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Japan
| | - Ichiro Shiojima
- Department of Medicine II, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Japan
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Martínez-Sande JL, García-Seara J, González-Melchor L, Rodríguez-Mañero M, Gómez-Otero I, González-Juanatey JR. Implante de marcapasos sin cables en un corazón trasplantado. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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41
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Taborsky M, Skala T, Kocher M, Fedorco M. Extraction of a dislocated leadless pacemaker in a patient with infective endocarditis and repeated endocardial and epicardial pacing system infections. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163:85-89. [DOI: 10.5507/bp.2018.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/13/2018] [Indexed: 11/23/2022] Open
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Burri H, Valiton V. Leadless pacing using the transcatheter pacing system (Micra TPS) in the real world: initial Swiss experience from the Romandie region—Authors’ reply. Europace 2019; 21:357. [DOI: 10.1093/europace/euy321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Haran Burri
- Cardiology Department, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
| | - Valérian Valiton
- Cardiology Department, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
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43
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Garweg C, Willems R. Leadless pacing using the transcatheter pacing system (Micra TPS) in the real world: initial Swiss experience from the Romandie region. Europace 2019; 21:356-357. [DOI: 10.1093/europace/euy272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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44
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Tam TK, Joseph Chan YS, Gary Chan CP, Anna Chan KY, Chan CY. Leadless pacemaker tether failure during recapture attempt leading to device embolization. HeartRhythm Case Rep 2019; 5:247-250. [PMID: 31193201 PMCID: PMC6520905 DOI: 10.1016/j.hrcr.2019.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Tsz Kin Tam
- Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | | | | | - Kin Yin Anna Chan
- Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Chi Yuen Chan
- Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
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45
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Della Rocca DG, Gianni C, Di Biase L, Natale A, Al-Ahmad A. Leadless Pacemakers: State of the Art and Future Perspectives. Card Electrophysiol Clin 2019; 10:17-29. [PMID: 29428139 DOI: 10.1016/j.ccep.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leadless pacemaker therapy is a new technology that aims at avoiding lead- and pocket-related complications of conventional transvenous and epicardial pacing. To date, 2 self-contained leadless pacemakers for right ventricular pacing have been clinically available: the Nanostim Leadless Pacemaker System and the Micra Transcatheter Pacing System. Additionally, a new multicomponent leadless pacemaker for endocardial left ventricular pacing has been proposed as an alternative choice for cardiac resynchronization therapy. In this review, we describe the state of the art of leadless pacing and compare the currently available devices with traditional transvenous leadless pacemakers.
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Affiliation(s)
- Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA.
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Wiles BM, Roberts PR. Design and evaluation of the Micra Transcatheter Pacing System for bradyarrhythmia management. Future Cardiol 2018; 15:9-15. [PMID: 30516083 DOI: 10.2217/fca-2018-0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Permanent cardiac pacemakers have traditionally comprised a surgically implanted subcutaneous pulse generator affixed to at least one transvenous pacing lead. Despite technological advances, implant-related complications and transvenous-lead failure rates have remained high. The Micra Transcatheter Pacing System is a miniaturized single chamber pacemaker that is implanted directly into the right ventricle, eliminating the subcutaneous pocket and creating a leadless pacemaker system. Registry data show an extremely high implant success rate, significantly lower major complication rates than transvenous pacemakers, stable pacing parameters and reliable battery performance. In this review we summarize the available clinical literature and highlight the promising efficacy and safety of the Micra Transcatheter Pacing System.
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Affiliation(s)
- Benedict M Wiles
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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47
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Stellbrink C, Hansky B, Meyer zu Vilsendorf D. Sondenlose Schrittmacher und subkutan implantierbare Kardioverter-Defibrillatoren. Internist (Berl) 2018; 59:999-1010. [DOI: 10.1007/s00108-018-0476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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McCanta AC, Morchi GS, Tuozo F, Berdjis F, Starr JP, Batra AS. Implantation of a leadless pacemaker in a pediatric patient with congenital heart disease. HeartRhythm Case Rep 2018; 4:506-509. [PMID: 30479947 PMCID: PMC6241038 DOI: 10.1016/j.hrcr.2018.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/21/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Anthony C McCanta
- Heart Institute, Children's Hospital Orange County, Orange, California.,University of California Irvine, Pediatric CardioPulmonary Center, Orange, California
| | - Gira S Morchi
- Heart Institute, Children's Hospital Orange County, Orange, California.,University of California Irvine, Pediatric CardioPulmonary Center, Orange, California
| | - Froilan Tuozo
- Heart Institute, Children's Hospital Orange County, Orange, California.,University of California Irvine, Pediatric CardioPulmonary Center, Orange, California
| | - Farhouch Berdjis
- Heart Institute, Children's Hospital Orange County, Orange, California
| | - Joanne P Starr
- Heart Institute, Children's Hospital Orange County, Orange, California.,University of California Irvine, Pediatric CardioPulmonary Center, Orange, California
| | - Anjan S Batra
- Heart Institute, Children's Hospital Orange County, Orange, California.,University of California Irvine, Pediatric CardioPulmonary Center, Orange, California
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49
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Leadless Pacemaker Implantation in a Transplanted Heart. ACTA ACUST UNITED AC 2018; 72:270-272. [PMID: 29779988 DOI: 10.1016/j.rec.2018.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/27/2018] [Indexed: 11/23/2022]
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50
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