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Haddadin F, Birnbaum G, Alhuneafat L, Jabri A, Ulhaq O, Giorgberidze I, Afshar H. A case of helix-fixation leadless pacemaker dislodgment and retrieval: The importance of achieving appropriate postimplant impedance. HeartRhythm Case Rep 2024; 10:375-377. [PMID: 38799587 PMCID: PMC11116960 DOI: 10.1016/j.hrcr.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Faris Haddadin
- Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Gilad Birnbaum
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Laith Alhuneafat
- Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Ahmad Jabri
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Owais Ulhaq
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Irakli Giorgberidze
- Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Hamid Afshar
- Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, Texas
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Mitacchione G, Schiavone M, Gasperetti A, Arabia G, Tundo F, Breitenstein A, Montemerlo E, Monaco C, Gulletta S, Palmisano P, Hofer D, Rovaris G, Dello Russo A, Biffi M, Pisanò ECL, Della Bella P, Di Biase L, Chierchia GB, Saguner AM, Tondo C, Curnis A, Forleo GB. Sex differences in leadless pacemaker implantation: A propensity-matched analysis from the i-LEAPER registry. Heart Rhythm 2023; 20:1429-1435. [PMID: 37481220 DOI: 10.1016/j.hrthm.2023.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The impact of sex in clinical and procedural outcomes in leadless pacemaker (LPM) patients has not yet been investigated. OBJECTIVE The purpose of this study was to investigate sex-related differences in patients undergoing LPM implantation. METHODS Consecutive patients enrolled in the i-LEAPER registry were analyzed. Comparisons between sexes were performed within the overall cohort using an adjusted analysis with 1:1 propensity matching for age and comorbidities. The primary outcome was the comparison of major complication rates. Sex-related differences regarding electrical performance and all-cause mortality during follow-up were deemed secondary outcomes. RESULTS In the overall population (n = 1179 patients; median age 80 years), 64.3% were men. After propensity matching, 738 patients with no significant baseline differences among groups were identified. During median follow-up of 25 [interquartile range 24-39] months, female sex was not associated with LPM-related major complications (hazard ratio [HR] 2.03; 95% confidence interval [CI] 0.70-5.84; P = .190) or all-cause mortality (HR 0.98; 95% CI 0.40-2.42; P = .960). LPM electrical performance results were comparable between groups, except for a higher pacing impedance in women at implant and during follow-up (24 months: 670 [550-800] Ω vs 616 [530-770] Ω; P = .014) that remained within normal limits. CONCLUSION In a real-world setting, we found differences in sex-related referral patterns for LPM implantation with an underrepresentation of women, although major complication rate and LPM performance were comparable between sexes. Female patients showed higher impedance values, which had no impact on overall device performance. Electrical parameters remained within normal limits in both groups during the entire follow-up.
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Affiliation(s)
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Fabrizio Tundo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | | | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - 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, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica-Ospedale "V. Fazzi", Lecce, Italy
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Luigi Di Biase
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Hospital, New York
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, 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, Milan, Italy
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Sultan A, Scheurlen C, Wörmann J, van den Bruck JH, Filipovic K, Erlhöfer S, Dittrich S, Schipper JH, Lüker J, Sinning JM, Nguyen DQ, Fischer S, Steven D, Winter S. First long-term outcome data for the MicraVR™ transcatheter pacing system: data from the largest prospective German cohort. Clin Res Cardiol 2023:10.1007/s00392-023-02286-1. [PMID: 37606854 DOI: 10.1007/s00392-023-02286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
AIMS The MicraVR™ transcatheter pacing system (TPS) has been implemented into clinical routine for several years. The primary recipients are patients in need for VVI pacing due to bradycardia in the setting of atrial fibrillation (AF). Implantation safety and acute success have been proven in controlled studies and registries. So far only few long-term real-life data on TPS exist. We report indication, procedure and outcome data from two high-volume implanting German centers. METHODS Between 2016 and 2019, 188 (of 303) patients were included. During follow-up (FU), TPS interrogation was performed after 4 weeks and thereafter every 6 months. RESULTS Indication for TPS implantation in 159/188 (85%) patients was permanent or intermittent AV block III° in the setting of atrial fibrillation. The mean procedure duration was 50 min [35.0-70.0]. The average acute values after system release were: thresholds: 0.5V [0.38-0.74]/0.24ms; R-wave sensing: 10.0mV [8.1-13.5]; impedance: 650 Ohm [550-783]; RV-pacing demand: 16.9% [0.9-75.9]; and battery status: 3.15 V [3.12-3.16]. During FU of 723.4 ± 597.9 days, neither pacemaker failure nor infections were reported. Long-term FU revealed: thresholds: 0.5V [0.38-0.63]/0.24 ms; sensing: 12.3mV [8.9-17.2]; impedance: 570 Ohm [488-633]; RV-pacing demand: 87.1% [29.5-98.6]; and battery status 3.02 V [3.0-3.1]. Forty-three patients died from not-device-related causes. CONCLUSION This to date largest German long-term dataset for MicraVR™ TPS implantation revealed stable device parameter. Foremost, battery longevity seems to fulfill predicted values despite a significant increase in RV-pacing demand over time and even in patients with consecutive AV-node ablation. Of note, no infections or system failure were observed.
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Affiliation(s)
- Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Cornelia Scheurlen
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jonas Wörmann
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Karlo Filipovic
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Susanne Erlhöfer
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sebastian Dittrich
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
| | | | | | | | - Daniel Steven
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany, Kerpener Str. 62, 50937, Cologne, Germany
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Nakamura T, Fukuzawa K, Kiuchi K, Takami M, Hirata KI. Leadless pacemaker: Should repositioning be needed despite a good threshold? Indian Pacing Electrophysiol J 2023; 23:130-132. [PMID: 37060993 PMCID: PMC10323175 DOI: 10.1016/j.ipej.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/04/2023] [Accepted: 04/08/2023] [Indexed: 04/17/2023] Open
Affiliation(s)
- Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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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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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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7
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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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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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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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11
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Darlington D, Brown P, Carvalho V, Bourne H, Mayer J, Jones N, Walker V, Siddiqui S, Patwala A, Kwok CS. Efficacy and safety of leadless pacemaker: A systematic review, pooled analysis and meta-analysis. Indian Pacing Electrophysiol J 2021; 22:77-86. [PMID: 34922032 PMCID: PMC8981159 DOI: 10.1016/j.ipej.2021.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/17/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Leadless pacemakers have been designed as an alternative to transvenous systems which avoid some of the complications associated with transvenous devices. We aim to perform a systematic review of the literature to report the safety and efficacy findings of leadless pacemakers. Methods We searched MEDLINE and EMBASE to identify studies reporting the safety, efficacy and outcomes of patients implanted with a leadless pacemaker. The pooled rate of adverse events was determined and random-effects meta-analysis was performed to compare rates of adverse outcomes for leadless compared to transvenous pacemakers. Results A total of 18 studies were included with 2496 patients implanted with a leadless pacemaker and success rates range between 95.5 and 100%. The device or procedure related death rate was 0.3% while any complication and pericardial tamponade occurred in 3.1% and 1.4% of patients, respectively. Other complications such as pericardial effusion, device dislodgement, device revision, device malfunction, access site complications and infection occurred in less than 1% of patients. Meta-analysis of four studies suggests that there was no difference in hematoma (RR 0.67 95%CI 0.21–2.18, 3 studies), pericardial effusion (RR 0.59 95%CI 0.15–2.25, 3 studies), device dislocation (RR 0.33 95%CI 0.06–1.74, 3 studies), any complication (RR 0.44 95%CI 0.17–1.09, 4 studies) and death (RR 0.45 95%CI 0.15–1.35, 2 studies) comparing patients who received leadless and transvenous pacemakers. Conclusion Leadless pacemakers are safe and effective for patients who have an indication for single chamber ventricular pacing and the findings appear to be comparable to transvenous pacemakers.
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Affiliation(s)
- Daniel Darlington
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
| | - Philip Brown
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Vanessa Carvalho
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Hayley Bourne
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Joseph Mayer
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Nathen Jones
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Vincent Walker
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Shoaib Siddiqui
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ashish Patwala
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Shing Kwok
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK; School of Medicine, Keele University, Keele, UK
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12
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BLANK EVAN, EL-CHAMI MIKHAEL, ORLOV MICHAEL. On the Management of Ventricular Arrhythmias Following Leadless Pacemaker Implantation. J Innov Card Rhythm Manag 2021; 12:4761-4763. [PMID: 34858669 PMCID: PMC8631368 DOI: 10.19102/icrm.2021.121106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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13
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Abstract
Leadless pacemakers (LPs) have revolutionized the field of pacing by miniaturizing pacemakers and rendering them completelty intracardiac, hence reducing complications related to pacemaker pockets and transvenous leads. However, first generation LPs appear to be associated with a higher rate of myocardial perforation as compared to transvenous pacemakers (TV-PPM). Currently, LPs are predominantly designed to pace the right ventricle with no LPs that provide atrial or biventricular pacing. In this article, we review the available data on LPs while advocating for the need for a randomized controlled trial comparing LPs to TV-PPMs. In addition, we review the future directions of leadless devices.
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14
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Ngo L, Nour D, Denman RA, Walters TE, Haqqani HM, Woodman RJ, Ranasinghe I. Safety and Efficacy of Leadless Pacemakers: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e019212. [PMID: 34169736 PMCID: PMC8403316 DOI: 10.1161/jaha.120.019212] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Leadless pacemaker is a novel technology, and evidence supporting its use is uncertain. We performed a systematic review and meta-analysis to examine the safety and efficacy of leadless pacemakers implanted in the right ventricle. Methods and Results We searched PubMed and Embase for studies published before June 6, 2020. The primary safety outcome was major complications, whereas the primary efficacy end point was acceptable pacing capture threshold (≤2 V). Pooled estimates were calculated using the Freedman-Tukey double arcsine transformation. Of 1281 records screened, we identified 36 observational studies of Nanostim and Micra leadless pacemakers, with most (69.4%) reporting outcomes for the Micra. For Micra, the pooled incidence of complications at 90 days (n=1608) was 0.46% (95% CI, 0.08%-1.05%) and at 1 year (n=3194) was 1.77% (95% CI, 0.76%-3.07%). In 5 studies with up to 1-year follow-up, Micra was associated with 51% lower odds of complications compared with transvenous pacemakers (3.30% versus 7.43%; odds ratio [OR], 0.49; 95% CI, 0.34-0.70). At 1 year, 98.96% (95% CI, 97.26%-99.94%) of 1376 patients implanted with Micra had good pacing capture thresholds. For Nanostim, the reported complication incidence ranged from 6.06% to 23.54% at 90 days and 5.33% to 6.67% at 1 year, with 90% to 100% having good pacing capture thresholds at 1 year (pooled result not estimated because of the low number of studies). Conclusions Most studies report outcomes for the Micra, which is associated with a low risk of complications and good electrical performance up to 1-year after implantation. Further data from randomized controlled trials are needed to support the widespread adoption of these devices in clinical practice.
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Affiliation(s)
- Linh Ngo
- School of Clinical Medicine The University of Queensland Brisbane QLD Australia.,Department of Cardiology The Prince Charles Hospital Brisbane QLD Australia.,Cardiovascular Centre E Hospital Hanoi Vietnam
| | - Daniel Nour
- Department of Cardiology The Prince Charles Hospital Brisbane QLD Australia
| | - Russell A Denman
- Department of Cardiology The Prince Charles Hospital Brisbane QLD Australia
| | - Tomos E Walters
- School of Clinical Medicine The University of Queensland Brisbane QLD Australia.,St Vincent's Private Hospital Northside Brisbane QLD Australia
| | - Haris M Haqqani
- School of Clinical Medicine The University of Queensland Brisbane QLD Australia.,Department of Cardiology The Prince Charles Hospital Brisbane QLD Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics Flinders University Adelaide SA Australia
| | - Isuru Ranasinghe
- School of Clinical Medicine The University of Queensland Brisbane QLD Australia.,Department of Cardiology The Prince Charles Hospital Brisbane QLD Australia
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15
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El-Chami MF, Shinn T, Bansal S, Martinez-Sande JL, Clementy N, Augostini R, Ravindran B, Sagi V, Ramanna H, Garweg C, Roberts PR, Soejima K, Stromberg K, Fagan DH, Zuniga N, Piccini JP. Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker. J Cardiovasc Electrophysiol 2021; 32:832-841. [PMID: 33428248 PMCID: PMC7986103 DOI: 10.1111/jce.14881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/19/2020] [Accepted: 01/02/2021] [Indexed: 12/01/2022]
Abstract
Background The feasibility and outcomes of concomitant atrioventricular node ablation (AVNA) and leadless pacemaker implant are not well studied. We report outcomes in patients undergoing Micra implant with concomitant AVNA. Methods Patients undergoing AVNA at the time of Micra implant from the Micra Transcatheter Pacing (IDE) Study, Continued Access (CA) study, and Post‐Approval Registry (PAR) were included in the analysis and compared to Micra patients without AVNA. Baseline characteristics, acute and follow‐up outcomes, and electrical performance were compared between patients with and without AVNA during the follow‐up period. Results A total of 192 patients (mean age 77.4 ± 8.9 years, 72% female) underwent AVNA at the time of Micra implant and were followed for 20.4 ± 15.6 months. AVNA patients were older, more frequently female, and tended to have more co‐morbid conditions compared with non‐AVNA patients (N = 2616). Implant was successful in 191 of 192 patients (99.5%). The mean pacing threshold at implant was 0.58 ± 0.35 V and remained stable during follow‐up. Major complications within 30 days occurred more frequently in AVNA patients than non‐AVNA patients (7.3% vs. 2.0%, p < .001). The risk of major complications through 36‐months was higher in AVNA patients (hazard ratio: 3.81, 95% confidence interval: 2.33–6.23, p < .001). Intermittent loss of capture occurred in three AVNA patients (1.6%), all were within 30 days of implant and required system revision. There were no device macrodislodgements or unexpected device malfunctions. Conclusion Concomitant AVN ablation and leadless pacemaker implant is feasible. Pacing thresholds are stable over time. However, patient comorbidities and the risk of major complications are higher in patients undergoing AVNA.
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Affiliation(s)
- Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia, USA
| | | | | | - Jose L Martinez-Sande
- Unidad de Arritmias, Servicio de Cardiología, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nicolas Clementy
- Department of Cardiologic Medicine, Centre Hospitalier Régional Universitaire de Tours - Hôpital Trousseau, Tours, France
| | - Ralph Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Venkata Sagi
- Baptist Heart Specialists, Baptist Medical Center, Jacksonville, Florida, USA
| | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, The Hauge, The Netherlands
| | - Christophe Garweg
- Department of Cardiovascular Sciences, Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Paul R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | | | | | | | - Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
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16
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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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17
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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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18
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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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