1
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Ip JE. The complex decision of leadless cardiac pacing: How to choose among the expanding options? Heart Rhythm 2024:S1547-5271(24)02825-X. [PMID: 38944319 DOI: 10.1016/j.hrthm.2024.06.051] [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: 06/14/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Affiliation(s)
- James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York.
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2
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Kusume T, Okano T, Onishi M, Terasawa M, Yazaki Y, Satomi K. Second Micra leadless pacemaker implantation by using intracardiac echocardiography. Pacing Clin Electrophysiol 2024; 47:554-557. [PMID: 37377404 DOI: 10.1111/pace.14770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
The strategy after battery depletion was not established in Micra leadless pacemaker system (Micra). There are still some concerns in the 2nd Micra implantation, such as the mechanical interaction between both devices. The position of the 2nd Micra should be placed apart from the 1st Micra. We present a case of 1st Micra battery depletion who successfully underwent the 2nd Micra implantation under the intracardiac echo guidance. In our case, intracardiac echo was a very effective tool for confirming the location of Micra implantation.
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Affiliation(s)
- Takahiro Kusume
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomoya Okano
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masahumi Onishi
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Muryo Terasawa
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshinao Yazaki
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Satomi
- Heart Rhythm Center, Tokyo Medical University Hospital, Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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3
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Santobuono VE, Basile P, Carella MC, Pomarico F, Favale S, Ciccone MM, Guaricci AI. Percutaneous extraction of a Micra AV transcatheter pacing system due to a rare sudden battery failure after 19 months from implantation: A first experience worldwide. Pacing Clin Electrophysiol 2024; 47:256-259. [PMID: 37208974 DOI: 10.1111/pace.14714] [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: 02/18/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Micra AV Transcatheter Pacing System (TPS) represents an innovative second-generation leadless pacemaker which represents an effective alternative to conventional devices in selected cases. Intrinsic malfunctions of these devices are rare, requiring sometimes their retrieval. When performed in experienced centers, this procedure is safe. CASE PRESENTATION We describe a case of sudden battery malfunction of a Micra AV TPS, which required the extraction and the placement of a new pacing system in the right ventricle. DISCUSSION This case, which has never been reported, highlights the need to a careful fluoroscopic evaluation and the usefulness of remote monitoring.
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Affiliation(s)
- Vincenzo Ezio Santobuono
- Interdisciplinary Department of Medicine, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Paolo Basile
- Interdisciplinary Department of Medicine, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Maria Cristina Carella
- Interdisciplinary Department of Medicine, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
- Department of Precision and Regenerative medicine and Ionian area, Policlinic University Hospital, Bari, Italy
| | - Francesca Pomarico
- Interdisciplinary Department of Medicine, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Stefano Favale
- Interdisciplinary Department of Medicine, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Marco Matteo Ciccone
- Interdisciplinary Department of Medicine, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Andrea Igoren Guaricci
- Interdisciplinary Department of Medicine, University Cardiology Unit, Policlinic University Hospital, Bari, Italy
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4
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Toon LT, Roberts PR. The Micra Transcatheter Pacing System: past, present and the future. Future Cardiol 2023; 19:735-746. [PMID: 38059460 DOI: 10.2217/fca-2023-0093] [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: 07/03/2023] [Accepted: 10/13/2023] [Indexed: 12/08/2023] Open
Abstract
Leadless permanent pacemakers represent an important innovation in cardiac device developments. Although transvenous permanent pacemakers have become indispensable in managing bradyarrhythmia and saving numerous lives, the use of transvenous systems comes with notable risks tied to intravascular leads and subcutaneous pockets. This drawback has spurred the creation of leadless cardiac pacemakers. Within this analysis, we compile existing clinical literature and proceed to evaluate the efficacy and safety of the Micra Transcatheter Pacing System. We also delve into the protocols for addressing a malfunctioning or end-of-life Micra as well as device extraction. Lastly, we explore prospects in this domain, such as the emergence of entirely leadless cardiac resynchronization therapy-defibrillator devices.
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Affiliation(s)
- Lin-Thiri Toon
- Cardiac Rhythm Management, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Paul R Roberts
- Cardiac Rhythm Management, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
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5
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Malaczynska-Rajpold K, Elliot M, Wijesuriya N, Mehta V, Wong T, Rinaldi CA, Behar JM. Leadless Cardiac Pacing: New Horizons. Cardiol Ther 2023; 12:21-33. [PMID: 36417178 PMCID: PMC9986180 DOI: 10.1007/s40119-022-00288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Since the introduction of transvenous cardiac pacing leads, pacemaker system design has remained similar for several decades. Progressive miniaturisation of electronic circuitry and batteries has enabled a smaller, single pacing unit comprising the intracardiac electrodes, generator and computer. This review explores the development of leadless pacing, the clinical trials comparing leadless to transvenous pacing in addition to the future developments of multi-chamber leadless pacing.
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Affiliation(s)
- Katarzyna Malaczynska-Rajpold
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK
| | - Mark Elliot
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Nadeev Wijesuriya
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Vishal Mehta
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK
| | - Christopher Aldo Rinaldi
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK
| | - Jonathan M Behar
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1, UK.
- St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
- Imaging Sciences and Biomedical Engineering, Kings College London, London, UK.
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6
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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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Blank EA, El-Chami MF, Wenger NK. Leadless Pacemakers: State of the Art and Selection of the Ideal Candidate. Curr Cardiol Rev 2023; 19:43-50. [PMID: 36999695 PMCID: PMC10518884 DOI: 10.2174/1573403x19666230331094647] [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: 08/08/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 04/01/2023] Open
Abstract
The field of cardiac pacing has been defined by constant development to provide efficacious, safe, and reliable therapy. Traditional pacing utilizes transvenous leads, which dwell in the venous system and place patients at risk for complications, including pneumothorax, bleeding, infection, vascular obstruction, and valvular compromise. Leadless pacemakers have been developed to overcome many of the challenges of transvenous pacing while providing safe and effective pacing therapy for an increasing population of patients. The Medtronic Micra transcatheter pacing system was approved by the FDA in April of 2016 and the Abbott Aveir pacemaker was approved in April of 2022. Several additional leadless pacemakers are in various stages of development and testing. There exists limited guidance on the selection of the ideal candidate for leadless pacemakers. Advantages of leadless pacemakers include decreased infection risk, overcoming limited vascular access, and avoidance of interaction with the tricuspid valve apparatus. Disadvantages of leadless pacemakers include right ventricular-only pacing, unclear lifecycle management, cost, perforation risk, and lack of integration with defibrillator systems. This review aims to provide an overview of the current state of the art of leadless pacemakers, currently approved systems, clinical trials and real-world evidence, considerations for patient selection, and future directions of this promising technology.
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Affiliation(s)
- Evan A. Blank
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F. El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia
| | - Nanette K. Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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8
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Ibrahim R, Khoury A, El-Chami MF. Leadless Pacing: Where We Currently Stand and What the Future Holds. Curr Cardiol Rep 2022; 24:1233-1240. [PMID: 35951261 DOI: 10.1007/s11886-022-01752-y] [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] [Accepted: 07/15/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Leadless pacemakers (LPs) are emerging as alternative cardiac implantable devices for the treatment of bradyarrhythmia. This article aims to review the data behind the safety and efficacy of these devices while highlighting their pros and cons. RECENT FINDINGS Prospective non-randomized studies and registries have found that LPs are associated with lower rate of device-related complications mainly driven by lower need for lead-related interventions as compared to traditional pacemakers. On the other hand, cardiac perforation appears to occur more frequently with LPs. LPs are associated with lower rate of device-related complications as compared to the traditional pacemakers. However, the rate of pericardial effusion is higher and is more severe. As we transition to multi-chamber LPs, it is important to ensure the safety and efficacy of these devices.
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Affiliation(s)
- Rand Ibrahim
- Department of Medicine, Division of Cardiology-Emory University School of Medicine, 12thFloor Medical Office Tower, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Alexandre Khoury
- Universite St Joseph School of Medicine-Beirut Lebanon, Beirut, Lebanon
| | - Mikhael F El-Chami
- Department of Medicine, Division of Cardiology-Emory University School of Medicine, 12thFloor Medical Office Tower, 550 Peachtree Street NE, Atlanta, GA, 30308, USA.
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9
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Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, Theuns DAMJ, Khelae SK, Kalil C, Zabala F, Stuehlinger M, Lenarczyk R, Clementy N, Tamirisa KP, Rinaldi CA, Knops R, Lau CP, Crozier I, Boveda S, Defaye P, Deharo JC, Botto GL, Vassilikos V, Oliveira MM, Tse HF, Figueroa J, Stambler BS, Guerra JM, Stiles M, Marques M. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS. Europace 2022; 24:1691-1708. [PMID: 35912932 DOI: 10.1093/europace/euac066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucas V Boersma
- Cardiology Department, St Antonius Hospital, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mikhael El-Chami
- Medicine/Cardiology Department, Emory University, Atlanta, GA, USA
| | - Clemens Steinwender
- Department of Cardiology and Internal Intensive Care, Kepler University Hospital Linz, Krankenhausstraße 9, Linz, Austria
| | - Pier Lambiase
- Department of Cardiology, UCL & Barts Heart Centre, Institute of Cardiovascular Science, UCL, Barts Heart Centre, London, UK
| | | | - Theofania Mela
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominic A M J Theuns
- Erasmus MC, Cardiology, Clinical Electrophysiology, CA Rotterdam, The Netherlands
| | | | - Carlos Kalil
- Cardiology Department, Hospital São Francisco da Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Federico Zabala
- Electrophysiology Unit, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Markus Stuehlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Disease, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Nicolas Clementy
- Cardiology Department, Centre Hospitalier Régional Universitaire de Tours, France
| | - Kamala P Tamirisa
- Cardiac Electrophysiology, Cardiac MRI, Texas Cardiac Arrhythmia Institute, 11970 N, Central Expressway, Dallas, TX, USA
| | | | - Reinoud Knops
- Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, Suite 1303, Central Building, 1 Pedder Street, Central, Hong Kong
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France.,Universitair Ziekenhuis Brussel-VUB, Heart Rhythm Management Centre, Brussels, Belgium, and INSERM U970, 75908 Paris Cedex 15 France
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Jean Claude Deharo
- Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France.,Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Vassilios Vassilikos
- Medical School, Aristotle University of Thessaloniki, Greece & Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| | - Hung Fat Tse
- The Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
| | - Jorge Figueroa
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Bruce S Stambler
- Unidad de Arritmias y Marcapasos, Sanatorio Allende, Obispo Oro 42, CP 5000, Córdoba, Argentina
| | - Jose M Guerra
- Piedmont Heart Institute, 275 Collier Road Northwest, Suite 500, Atlanta, GA 30309, USA
| | - Martin Stiles
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Manlio Marques
- Waikato Clinical School, University of Auckland, Auckland, New Zealand.,National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
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10
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Mor-Welch T, Butcher C, Sporton S, Dhinoja M. The use of a needle’s eye snare to extract a leadless pacemaker in a patient with a persistent bacteremia. HeartRhythm Case Rep 2022; 8:699-701. [PMID: 36310717 PMCID: PMC9596358 DOI: 10.1016/j.hrcr.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | - Mehul Dhinoja
- Address reprint requests and correspondence: Dr Mehul Dhinoja, St. Bartholomew’s Hospital, W Smithfield, London EC1A 7BE, United Kingdom.
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11
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Nicosia A, Iacopino S, Nigro G, Zucchelli G, Tomasi L, D'Agostino C, Ziacchi M, Piacenti M, De Filippo P, Sgarito G, Campisi G, Nicolis D, Foti R, Palmisano P. Performance of transcatheter pacing system use in relation to patients' age. J Interv Card Electrophysiol 2022; 65:103-110. [PMID: 35435630 DOI: 10.1007/s10840-022-01208-x] [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: 11/10/2021] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Real-world safety data on the use of transcatheter pacing systems particularly in very elderly patients is still limited. The aim of this analysis was to investigate the effect of age on the safety and efficacy of leadless pacemaker implant. METHODS From May 2016 through July 2019, 577 patients were implanted with a leadless single-chamber pacemaker according to current pacing indication in 15 Italian cardiologic centers. The population was divided into age quartiles for evaluation, including (1) < 70 years, (2) 70-77 years, (3) 78-83 years, and (4) ≥ 83 years. Procedural data, complications, and electrical parameters were collected at baseline and during the follow-up. RESULTS Procedural-related complication occurrence was very low (< 1.0%) and similar in the four subgroups according to age even if the older patients were more frail. No cardiac tamponade was reported. Among the groups, no difference was observed in procedural time, fluoroscopy time duration, and electrical parameters (mean pacing impedance: 750 ± 192 and 599 ± 156, mean pacing threshold: 0.7 ± 0.5 and 0.7 ± 0.6, and mean right ventricular sensing 10.7 ± 6.1 and 11.5 ± 4.8 at implant and last follow-up, respectively). CONCLUSIONS The reported data demonstrated a high degree of safety during leadless implant across all patient ages. Procedural complications and device electrical measurements were similar among the different ages.
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Affiliation(s)
- Antonino Nicosia
- Azienda Sanitaria Provinciale di Ragusa, Ospedale Giovanni Paolo II, C.da Cisternazzi, Ragusa, Italy.
| | | | - Gerardo Nigro
- Azienda Ospedaliera Dei Colli - Ospedale Monaldi, Naples, Italy
| | | | - Luca Tomasi
- Azienda Ospedaliera Universitaria, Ospedale Borgo Trento, Verona, Italy
| | | | - Matteo Ziacchi
- Azienda Ospedaliera Sant'Orsola Malpighi, Bologna, Italy
| | | | | | | | - Giuseppe Campisi
- Azienda Sanitaria Provinciale di Ragusa, Ospedale Giovanni Paolo II, C.da Cisternazzi, Ragusa, Italy
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12
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Neugebauer F, Noti F, van Gool S, Roten L, Baldinger SH, Seiler J, Madaffari A, Servatius H, Ryser A, Tanner H, Reichlin T, Haeberlin A. Leadless atrio-ventricular synchronous pacing in an outpatient setting - early lessons learned on factors affecting atrio-ventricular synchrony. Heart Rhythm 2021; 19:748-756. [PMID: 34971817 DOI: 10.1016/j.hrthm.2021.12.025] [Citation(s) in RCA: 9] [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: 09/11/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Leadless pacemakers (PMs) capable of atrio-ventricular (AV) synchronous pacing have recently been introduced. Initial feasibility studies were promising, but limited to just a few minutes of AV synchronous pacing. Real-world long-term data on AV synchrony and programming adjustments affecting AV synchrony in outpatients are lacking. OBJECTIVE To investigate AV synchrony and influences of PM programming adjustments in outpatients with leadless VDD PMs. METHODS All patients who received a leadless VDD PM (Micra™ AV, Medtronic, US) between 07/2020 and 05/2021 at our center were included in this observational study. AV synchrony was assessed repeatedly postoperatively and during follow-up using Holter ECG recordings. AV synchrony was defined as a QRS complex preceded by a p-wave within 300ms. The impact of programming changes during follow-up on AV synchrony was studied. RESULTS 816 hours of Holter ECG from 20 outpatients were analyzed. During predominantly paced episodes (≥80% ventricular pacing), median AV synchrony was 91% (IQR 34-100%) when patients had sinus rates 50-80/min. Median AV synchrony was lower when patients had sinus rates >80/min (33%, IQR 29-46%, p<0.001). During a stepwise optimization protocol, AV synchrony could be improved (p<0.038). Multivariate analysis showed that a shorter maximum A3 window end (p<0.001), a lower A3 threshold (p=0.046), and minimum A4 threshold (p<0.001) improved AV synchrony. CONCLUSION Successful VDD pacing in the outpatient setting during higher sinus rates is more difficult to achieve than can be presumed based on the initial feasibility studies. The devices often require multiple reprogramming to maximize AV sequential pacing.
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Affiliation(s)
- Felix Neugebauer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan van Gool
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Ryser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland.
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