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Golemi L, Chitturu N, Patel H, Chen Y, Hussein A. Navigating Complex Anatomy During Leadless Pacemaker Implantation. JACC Case Rep 2023; 18:101912. [PMID: 37545684 PMCID: PMC10401061 DOI: 10.1016/j.jaccas.2023.101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 08/08/2023]
Abstract
Transvenous pacemakers may lead to wound site complications, such as hematomas and infections. Leadless pacemakers have eliminated these risks. However, when the central venous and/or cardiac anatomy are challenging, their implantation technique may require modification(s). Here, we discuss 3 cases of successful leadless pacemaker implantation in patients with a challenging anatomy. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | | | | | | | - Ahmed Hussein
- Address for correspondence: Dr Ahmed Hussein, Saint Louis University Hospital, 1201S Grand Blvd, St. Louis, Missouri 63014, USA.
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2
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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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Afzal MR, Jamal SM, Son JH, Chung JH, Gabriels J, Okabe T, Hummel JD, Augostini RS. Tips and Tricks for Safe Retrieval of Tine-based Leadless Pacemakers. J Innov Card Rhythm Manag 2021; 12:4562-4568. [PMID: 34234991 PMCID: PMC8225307 DOI: 10.19102/icrm.2021.120606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
As leadless pacing (LP) use is expected to increase, it becomes increasingly essential that operators become familiar with the tools and techniques needed to retrieve an LP successfully. The purpose of this review is to describe a stepwise approach for the successful retrieval of tine-based LP devices, including ways to minimize complications.
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Affiliation(s)
- Muhammad R Afzal
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shakeel M Jamal
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI, USA
| | - Jae H Son
- Department of Internal Medicine, Fairfield Medical Center, Lancaster, OH, USA
| | - Jae-Hoon Chung
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James Gabriels
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Shah K, Patel S, Hanson I, Williamson B, Kutinsky I, Dixon S, Haines DE, Mehta NK. Navigating inferior vena cava filters in invasive cardiology procedures: A systematic review. J Cardiovasc Electrophysiol 2021; 32:1440-1448. [PMID: 33772931 DOI: 10.1111/jce.15010] [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: 01/31/2021] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transfemoral venous access (TFV) is the cornerstone of minimally invasive cardiac procedures. Although the presence of inferior vena cava filters (IVCFs) was considered a relative contraindication to TFV procedures, small experiences have suggested safety. We conducted a systematic review of the available literature on cardiac procedural success of TFV with IVCF in-situ. METHODS Two independent reviewers searched PubMed, EMBASE, SCOPUS, and Google Scholar from inception to October 2020 for studies that reported outcomes in patients with IVCFs undergoing TFV for invasive cardiac procedures. We investigated a primary outcome of acute procedural success and reviewed the pooled data for patient demographics, procedural complications, types of IVCF, IVCF dwell time, and procedural specifics. RESULTS Out of the 120 studies initially screened, 8 studies were used in the final analysis with a total of 100 patients who underwent 110 procedures. The most common IVCF was the Greenfield Filter (36%), 60% of patients were males and the mean age was 67.8 years. The overall pooled incidence of acute procedural success was 95.45% (95% confidence interval = 89.54-98.1) with no heterogeneity (I2 = 0%, p = 1) and there were no reported filter-related complications. CONCLUSION This systematic review is the largest study of its kind to demonstrate the safety and feasibility of TFV access in a variety of cardiac procedures in the presence of IVCF.
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Affiliation(s)
- Kuldeep Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Sati Patel
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ivan Hanson
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Brian Williamson
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Ilana Kutinsky
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - David E Haines
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Nishaki Kiran Mehta
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.,Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
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Sanchez R, Nadkarni A, Buck B, Daoud G, Koppert T, Okabe T, Houmsse M, Weiss R, Augostini R, Hummel JD, Kalbfleisch S, Daoud EG, Afzal MR. Incidence of pacing-induced cardiomyopathy in pacemaker-dependent patients is lower with leadless pacemakers compared to transvenous pacemakers. J Cardiovasc Electrophysiol 2020; 32:477-483. [PMID: 33205561 PMCID: PMC7984287 DOI: 10.1111/jce.14814] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023]
Abstract
Introduction Frequent right AQ4ventricular pacing (≥40%) with a transvenous pacemaker (TVP) is associated with the risk of pacing‐induced cardiomyopathy (PICM). Leadless pacemakers (LPs) have distinct physical and mechanical differences from TVP. The risk of PICM with LP is not known. To identify incidence, predictors, and long‐term outcomes of PICM in LP and TVP patients. Methods The study comprised all pacemaker‐dependent patients with LP or TVP who had left ventricular ejection fraction (LVEF) of ≥50 from 2014 to 2019. The incidence of PICM (≥10% LVEF drop) was assessed with an echocardiogram. Predictors for PICM were identified using multivariate analysis. Long‐term outcomes after cardiac resynchronization (CRT) were assessed in both groups. Results A total of 131 patients with TVP and 67 with LP comprised the study. All patients in the TVP group and the majority in the LP group underwent atrioventricular node ablation. The mean follow‐up duration in TVP and LP groups was 592 ± 549 and 817 ± 600 days, respectively. A total of 18 (13.7%) patients in TVP and 2 (3%) in LP developed PICM after a median duration of 254 (interquartile range: 470) days. The incidence of PICM was significantly higher with TVP compared with LP (p = .02). TVP as pacing modality was a positive (odds ratio [OR]: 1.07) while age was negative (OR: 0.94) predictor for PICM on multivariable analysis. Both patients in LP and all except two in the TVP group responded to CRT. Conclusion Incidence of PICM is significantly lower with LP compared with TVP in pacemaker‐dependent patients. Age and TVP as pacing modality were predictors for PICM.
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Affiliation(s)
- Reynaldo Sanchez
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anish Nadkarni
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin Buck
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Georges Daoud
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tanner Koppert
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph Augostini
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven Kalbfleisch
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Houmsse M, Karki R, Gabriels J, Reinig M, Patel D, Hussain SK, Gandhi GD, Lloyd MS, Makary MS, Okabe T, Tamirisa K, Joza J, Patel A, Afzal MR, Epstein LM, Cha Y. Implantation of leadless pacemakers via inferior vena cava filters is feasible and safe: Insights from a multicenter experience. J Cardiovasc Electrophysiol 2020; 31:3277-3285. [DOI: 10.1111/jce.14776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Roshan Karki
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - James Gabriels
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | | | | | - Sarah K. Hussain
- Division of Cardiology Penn State Health Milton S Hershey Medical Center Hershey Pennsylvania USA
| | | | - Michael S. Lloyd
- Division of Cardiology, Department of Medicine Emory University Atlanta Georgia USA
| | - Mina S. Makary
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | | | - Jacqueline Joza
- Division of Cardiology McGill University Health Center Montreal Canada
| | - Apoor Patel
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | - Muhammad R. Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Laurence M. Epstein
- Department of Cardiology Northwell Health, Manhasset, NY/Long Island Jewish Medical Center New Hyde Park New York USA
| | - Yong‐Mei Cha
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
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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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Matsuhashi N, Suzuki N, Goto E, Murayama Y, Hasegawa K, Horinaka S. Successful implantation of leadless pacemaker in patient with the Günther Tulip inferior vena cava filter. J Cardiol Cases 2019; 19:70-73. [PMID: 31193668 DOI: 10.1016/j.jccase.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022] Open
Abstract
Leadless pacemakers have many advantages for some patients in preventing lead- and pocket-related complications. The traveling of the femoral vein is important in the context of normal approach site choice for leadless pacemakers. In this case, the leadless pacemaker could be successfully implanted without disrupting the inferior vena cava filter by using intravascular ultrasound in a hemodialysis patient with complete atrioventricular block and atrial fibrillation who had obstruction of the bilateral subclavian and right femoral veins, and travel abnormality of the left common iliac vein. <Learning objective: The leadless pacemaker is a useful option in patients with complex vascular complications and hemodialysis. However, there are several listed contraindications such as the presence of inferior vena cava (IVC) filter that was excluded in the large-scale trials to leadless pacemakers. Intravascular ultrasound is a useful tool to place the leadless pacemaker without disrupting IVC filter to maintain its filtering capability.>.
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Affiliation(s)
- Noritaka Matsuhashi
- Department of Cardiology and Nephrology, Dokkyo Medical University, Tochigi, Japan
| | - Naoko Suzuki
- Department of Cardiology and Nephrology, Dokkyo Medical University, Tochigi, Japan
| | - Eri Goto
- Department of Cardiology and Nephrology, Dokkyo Medical University, Tochigi, Japan
| | - Yoshiki Murayama
- Department of Cardiology and Nephrology, Dokkyo Medical University, Tochigi, Japan
| | - Komi Hasegawa
- Department of Cardiology and Nephrology, Dokkyo Medical University, Tochigi, Japan
| | - Shigeo Horinaka
- Department of Cardiology and Nephrology, Dokkyo Medical University, Tochigi, Japan
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Mendelson TB, Santangeli P, Frankel DS, Arkles JS, Supple GE, Lin D, Riley MP, Callans DJ, Nazarian S, Hyman MC, Kumareswaran R, Epstein AE, Deo R, Dixit S, Garcia FC, Zado ES, Hutchinson MD, Sadek MM, Cooper JM, Marchlinski FE, Trerotola SO, Schaller RD. Feasibility of complex transfemoral electrophysiology procedures in patients with inferior vena cava filters. Heart Rhythm 2019; 16:873-878. [DOI: 10.1016/j.hrthm.2018.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 12/19/2022]
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Cronin B, Essandoh MK. Update on Cardiovascular Implantable Electronic Devices for Anesthesiologists. J Cardiothorac Vasc Anesth 2018; 32:1871-1884. [DOI: 10.1053/j.jvca.2017.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/11/2022]
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Lee JZ, Mulpuru SK, Shen WK. Leadless pacemaker: Performance and complications. Trends Cardiovasc Med 2018; 28:130-141. [DOI: 10.1016/j.tcm.2017.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
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Flores E, Patel M, Orme G, Su W. Successful implantation of a Micra leadless pacemaker via collateral femoral vein and inferior vena cava filter. Clin Case Rep 2018. [PMID: 29531727 PMCID: PMC5838272 DOI: 10.1002/ccr3.1386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This case details the successful implementation of a leadless pacemaker device in a patient with multiple venous occlusions and an IVC filter. As the incidence of IVC filters increases in patients with dysrhythmias, further investigations are required to determine the risk and safety of leadless pacemaker placement in this population.
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Affiliation(s)
- Erica Flores
- Department of Cardiology University of Arizona College of Medicine - Phoenix 1111 E. McDowell Road Phoenix 85006 Arizona
| | - Mayur Patel
- Department of Internal Medicine University of Arizona College of Medicine - Phoenix 1111 E. McDowell Road Phoenix 85006 Arizona
| | - Geoffery Orme
- Department of Cardiology University of Arizona College of Medicine - Phoenix 1111 E. McDowell Road Phoenix 85006 Arizona
| | - Wilber Su
- Department of Cardiology University of Arizona College of Medicine - Phoenix 1111 E. McDowell Road Phoenix 85006 Arizona
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Gabriels J, Fan R, Beldner S, Jadonath R, Weinberg M, Patel A. Balloon Dilation of an Inferior Vena Cava Filter to Implant a Leadless Pacemaker. JACC Clin Electrophysiol 2017; 3:1605-1606. [DOI: 10.1016/j.jacep.2017.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/15/2017] [Indexed: 11/16/2022]
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