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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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2
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Roberts PR, Clémenty N, Mondoly P, Winter S, Bordachar P, Sharman D, Jung W, Eschalier R, Theis C, Defaye P, Anderson C, Pol A, Butler K, Garweg C. A leadless pacemaker in the real-world setting: Patient profile and performance over time. J Arrhythm 2023; 39:1-9. [PMID: 36733321 PMCID: PMC9885317 DOI: 10.1002/joa3.12811] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/24/2022] [Indexed: 01/10/2023] Open
Abstract
Background While prior Micra trials demonstrated a high implant success rate and favorable safety and efficacy results, changes in implant populations and safety over time is not well studied. The objective of this analysis was to report the performance of Micra in European and Middle Eastern patients and compare to the Micra Investigational Device Exemption (IDE) and Micra Post Approval Registry (PAR) studies. Methods The prospective, single-arm Micra Acute Performance European and Middle Eastern (MAP EMEA) registry was designed to further study the performance of Micra in patients from EMEA. The primary endpoint was to characterize acute (30-day) major complications. Electrical performance was analyzed. The major complication rate through 12 months was compared with the IDE and PAR studies. Results The MAP EMEA cohort (n = 928 patients) had an implant success rate of 99.9% and were followed for an average of 9.7 ± 6.5 months. Compared to prior studies, MAP EMEA patients were more likely to have undergone dialysis and have a condition which precluded the use of a transvenous pacemaker (p < .001). Within 30 days of implantation, the MAP EMEA cohort had a major complication rate of 2.59%. Mean pacing thresholds were low and stable through 12 months (0.61 ± 0.40 V at 0.24 ms at implant and 12 months). Through 12 months post-implantation, the major complication rate for MAP EMEA was not significantly different from IDE (p = .56) or PAR (p = .79). Conclusion Despite patient differences over time, the Micra leadless pacemaker was implanted with a high success rate and low complication rate, in-line with prior reports.
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Affiliation(s)
- Paul R. Roberts
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | | | - Pierre Mondoly
- Centre Hospitalier Universitaire de ToulouseToulouseFrance
| | | | | | | | - Werner Jung
- Schwarzwald‐Baar Klinikum Villingen‐SchwenningenVillingen‐SchwenningenGermany
| | - Romain Eschalier
- Université Clermont Auvergne and Cardiology Department, CHU Clermont‐Ferrand, CNRSSIGMA Clermont, Institut PascalClermont‐FerrandFrance
| | | | - Pascal Defaye
- Centre Hospitalier Universitaire de GrenobleLa TroncheFrance
| | | | - Aimée Pol
- Medtronic Bakken Research CenterMaastrichtThe Netherlands
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3
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Palmisano P, Iacopino S, De Vivo S, D'Agostino C, Tomasi L, Startari U, Ziacchi M, Pisanò ECL, Santobuono VE, Caccavo VP, Sgarito G, Rillo M, Nicosia A, Zucchelli G. Leadless transcatheter pacemaker: Indications, implantation technique and peri-procedural patient management in the Italian clinical practice. Int J Cardiol 2022; 365:49-56. [PMID: 35907505 DOI: 10.1016/j.ijcard.2022.07.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/03/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Safety and efficacy of leadless pacemakers (L-PM) have been demonstrated in multiple clinical trials, but real-world data on patient selection, implantation technique, and peri-procedural patient management in a clinical practice setting are lacking. METHODS Consecutive patients undergoing L-PM implantation in 14 Italian centers were followed in a prospective, multicentre, observational project. Data on baseline patient characteristics, clinical indications, implantation procedure, and peri-procedural patient management were collected. The rate and nature of device-related complications were also recorded. RESULTS A total of 782 L-PM patients (68.4% male, 75.6 ± 12.4 years) were included in the analysis. The main patients-related reason leading to the choice of implanting a L-PM rather than a conventional PM was the high-risk of device infection (29.5% of cases). The implantation success rate was 99.2%. The median duration of the procedure was 46 min. In 90% of patients the device was implanted in the septum. Of patients on oral anticoagulant therapy (OAT) (n = 498) the implantation procedure was performed without interrupting (17.5%) or transiently interrupting OAT without heparin bridging (60.6%). During a median follow-up of 20 months major device-related complications occurred in 7 patients (0.9%): vascular access-site complications in 3 patients, device malfunction in 2 patients, pericardial effusion/cardiac tamponade in one patient, device migration in one patient. CONCLUSIONS In the real world setting of Italian clinical practice L-PM is often reserved for patients at high-risk of infection. The implantation success rate was very high and the risk of major complications was low. Peri-procedural management of OAT was consistent with available scientific evidence.
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Affiliation(s)
| | | | | | | | - Luca Tomasi
- U.O.C. Cardiologia - Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Matteo Ziacchi
- Istituto di Cardiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | | | | | - Antonino Nicosia
- Azienda Sanitaria Provinciale, Ospedale Giovanni Paolo II, Ragusa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiothoracic and Vascular department, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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4
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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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5
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Vincent L, Grant J, Peñalver J, Ebner B, Maning J, Olorunfemi O, Goldberger JJ, Mitrani RD. Early Trends in Leadless Pacemaker Implantation: Evaluating Nationwide In-Hospital Outcomes. Heart Rhythm 2022; 19:1334-1342. [DOI: 10.1016/j.hrthm.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/25/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
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6
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Tajima A, Mizutani Y, Kanasiro M, Amano T. Difficulty removing a leadless pacemaker in a post-transfusion patient. BMJ Case Rep 2021; 14:14/10/e246625. [PMID: 34706922 PMCID: PMC8552136 DOI: 10.1136/bcr-2021-246625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 99-year-old woman with atrial fibrillation bradycardia and symptomatic long pauses underwent a leadless pacemaker implantation after red blood cell transfusion due to anaemia. The patient's blood tests after transfusion showed hypercoagulability; haematocrit, haemoglobin and fibrinogen levels were increased from 24.5% to 33.2%, 76 g/L to 111g/L, and 346 mg/dL to 646 mg/dL, respectively. Blood tests showed no hereditary hypercoagulability disorder and she had no history of thrombophilia. A leadless pacemaker was implanted in the correct position in the right ventricle. Heparin was administered after sheath insertion and the leadless pacemaker system was thoroughly flushed with heparinised saline before the tether was cut; however, removing the tether after leadless pacemaker implantation was difficult because clots had formed on the tether.
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Affiliation(s)
- Atomu Tajima
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan.,Aichi Medical University, Nagakute, Aichi, Japan
| | - Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Masaaki Kanasiro
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
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7
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Haeberlin A, Kozhuharov N, Knecht S, Tanner H, Schaer B, Noti F, Osswald S, Servatius H, Baldinger S, Seiler J, Lam A, Mosher L, Sticherling C, Roten L, Kühne M, Reichlin T. Leadless pacemaker implantation quality: importance of the operator's experience. Europace 2021; 22:939-946. [PMID: 32361742 DOI: 10.1093/europace/euaa097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/04/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Leadless cardiac pacemaker (PM) implantation differs from conventional PM implantation. While the procedure has been considered safe, recent real-world data raised concerns about the learning curve of new operators and their implantation quality. The goal of this study was to investigate the influence of the first operator's experience on leadless PM implantation quality and procedural efficiency. METHODS AND RESULTS We performed a bicentric analysis of all Micra TPS™ implantations in two large tertiary referral hospitals. We assessed both leadless PM implantation quality based on the absence of complications (requiring intervention or prolonged hospitalization), good electrical performance (pacing threshold ≤ 1.5 V/0.24 ms, R-wave amplitude > 5 mV), and acceptable fluoroscopy duration (<10 min) as well as procedural efficiency in relation to the operator's experience. Univariate and multivariate logistic regression analyses were performed to identify predictors for implantation quality and procedural efficiency. Leadless PM implantation was successful in 106/111 cases (95.5%). Three patients (2.7%) experienced acute complications (one cardiac tamponade, one femoral bleeding, one posture-related PM exit block). Multivariate analysis showed that implantation quality of more experienced first operators was higher [odds ratio 1.09 (95% confidence interval 1.00-1.19), P = 0.05]. Procedural efficiency increased with operator experience as evidenced by an inverse correlation of procedure time, time to the first deployment, fluoroscopy time, and the number of procedures performed (all P < 0.05). CONCLUSION The operator's learning curve is a critical factor for leadless PM implantation quality and procedural efficiency.
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Affiliation(s)
- Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland.,Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Av. de Magellan, 33604 Pessac, France.,Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Beat Schaer
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Samuel Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Luke Mosher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
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8
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Lenarczyk R, Boveda S, Mansourati J, Russo V, Marijon E, Lane DA, Dagres N, Potpara TS. Peri-procedural management, implantation feasibility, and short-term outcomes in patients undergoing implantation of leadless pacemakers: European Snapshot Survey. Europace 2021; 22:833-838. [PMID: 32073116 DOI: 10.1093/europace/euaa023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to assess procedural settings, safety measures, and short-term outcomes associated with implantation of leadless pacemakers (LLPM), across a broad range of tertiary European electrophysiology centres. An internet-based electronic questionnaire (30 questions) concerning implantation settings, peri-procedural routines, complications, and in-hospital patient outcomes was circulated to centres routinely implanting both LLPMs and transvenous pacemakers (TV-PM). The centres were requested to prospectively include consecutive patients implanted with either LLPMs or TV-PMs during the 10-week enrolment period. Overall, 21 centres from four countries enrolled 825 consecutive patients between November 2018 and January 2019, including 69 (9%) implanted with LLPMs. Leadless pacemakers were implanted mainly under local anaesthesia (69%), by an electrophysiologist (60%), in the electrophysiology laboratory (71%); 95% of patients received prophylactic antibiotics prior to implantation. Most patients on chronic oral anticoagulation were operated on-drug (35%), or during short-term (to 48 h) drug withdrawal (54%). Implantation was successful in 98% of patients and the only in-hospital procedure-related complication was groyne haematoma in one patient. This EHRA snapshot survey provides important insights into LLPM implantation routines and patient outcomes. These findings suggest that despite the unfavourable clinical profile of pacemaker recipients, LLPM implantation is associated with relatively low risk of complications and good short-term outcomes.
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Affiliation(s)
- Radosław Lenarczyk
- First Department of Cardiology and Angiology, Silesian Centre for Heart Disease, Curie-Sklodowskiej Str 9, 41-800 Zabrze, Poland
| | - Serge Boveda
- Cardiology - Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France.,Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette Brussels, Belgium.,Paris University, PARCC-INSERM, 56 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest, 9 Rue Félix le Dantec, 29200 Brest, France.,ORPHY, Université de Bretagne Occidentale, 3 Rue des Archives, 29238 Brest, France
| | - Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Via Santa Maria di Costantinopoli 104, Napoli, NA 80138, Italy
| | - Eloi Marijon
- Paris University, PARCC-INSERM, 56 Rue Leblanc, 75908 Paris Cedex 15, France.,Cardiology Department, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Søndre Skovvej 15, Forskningens Hus, 9000 Aalborg, Denmark
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, dr Subotića Starijeg 8, 11000 Belgrad, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Visegradska 26, 11000 Belgrade, Serbia
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9
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Yamao K, Hachiya H, Kusa S, Miwa N, Sato Y, Hara S, Ohya H, Iesaka Y, Sasano T. Individualized left anterior oblique projection based on pigtail catheter visualization facilitates leadless pacemaker implantation. J Arrhythm 2021; 37:676-682. [PMID: 34141021 PMCID: PMC8207349 DOI: 10.1002/joa3.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/15/2021] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pacemaker positioning on the right ventricular (RV) septum during implantation is conventionally conducted utilizing two fixed fluoroscopy angles, a 45° left anterior oblique (LAO) and 35° right anterior oblique projection. However, placement location can be suboptimal, especially for leadless pacemakers (LPMs). OBJECTIVE To evaluate the safety and ease of LPM implantation using individualized LAO projection. METHODS Consecutive patients undergoing LPM implantation were prospectively included. The angle of the RV septum was recorded for each patient by studying the angle at which an RV pigtail catheter (RV-PC) could be seen edge on. This was then used as the preferred LAO projection angle for that patient. We evaluated the success rate and safety of this method. We also compared the RV septum angle as measured by this method versus that measured by chest CT. RESULTS Of the 31 patients (mean age 80.6 ± 7.0 years, 15 females), LPM implantation was successful in 30. The pacemaker was implanted on the RV septum in 29 and on the free wall in one. LPM implantation was abandoned for anatomical reasons in one. Complications were limited to a groin arteriovenous fistula and one deep vein thrombosis. The angle of RV septum as measured by pigtail catheter and chest CT was not significantly different (CT: 54.8 ± 6.0°, RV pigtail catheter: 52.9 ± 6.1°, P = .07). CONCLUSIONS Using an RV-PC to determine the preferred angle of LAO projection facilitates differentiation between the RV septum and free wall, which in turn facilitates optimal LPM placement.
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Affiliation(s)
- Kazuya Yamao
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | | | - Shigeki Kusa
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Naoyuki Miwa
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Yoshikazu Sato
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Satoshi Hara
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Hiroaki Ohya
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Yoshito Iesaka
- Cardiovascular CenterTsuchiura Kyodo HospitalTsuchiuraJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
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10
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Sano M, Urushida T, Sakakibara T, Naruse Y, Maekawa Y. Tortuous inferior vena cava with severe scoliosis: An impediment to successful leadless pacemaker implantation. J Cardiol Cases 2021; 23:218-220. [PMID: 33995700 DOI: 10.1016/j.jccase.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022] Open
Abstract
Both a multicenter cohort and a post-approval registry of the Micra™ transcatheter pacemaker (Medtronic, Minneapolis, MN, USA) reported high successful implantation rates (>99%) with long-term stability of electrical performance and long-term safety. Therefore, there has been little discussion on the causes of cases of failure in terms of anatomical findings. We report a case of failure of implantation of the Micra because of a tortuous inferior vena cava (IVC) secondary to severe scoliosis. A retrospective assessment of 3D reconstructed computed tomography imaging could visualize the configuration of the IVC-right atrium junction. A preprocedural anatomical assessment may help to predict the implantability of the transcatheter leadless pacemaker or to image the manipulation of the delivery catheter. <Learning objective: The Micra™ leadless pacemaker had high successful implantation rates (>99%). There has been little discussion on the causes of cases of failure in terms of anatomical findings. We report a case of failure of implantation of the Micra device because of a tortuous inferior vena cava secondary to severe scoliosis. A preprocedural 3D reconstructed computed tomography may help to predict the procedural difficulty of the Micra implantation or to image a manipulation of the delivery catheter.>.
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Affiliation(s)
- Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
| | - Tomoaki Sakakibara
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu 431-3192, Japan
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11
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Palmisano P, Guido A, Panico V, Chiuri MD, Chiarillo MV, Sergi C, Ponzetta MA, Zaccaria M, Accogli M. Leadless pacemaker versus transvenous single-chamber pacemaker therapy: peri-procedural aspects, utilization of medical resources and patient acceptance. Expert Rev Med Devices 2021; 18:483-491. [PMID: 33888044 DOI: 10.1080/17434440.2021.1921573] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Leadless pacemaker (L-PM) have been developed in order to overcome the lead- and pocket-related complications associated with transvenous pacemaker (T-PM). The impact of L-PM implantation on the utilization of medical resources, patient comfort and therapy acceptance could differ from that of T-PM. RESEARCH DESIGN AND METHODS Prospective, single-center study enrolling 243 consecutive patients undergoing PM implantation. Propensity matching for baseline characteristics yielded 77 matched pairs. Procedural data, patient acceptance (assessed by Florida Patient Acceptance Survey, FPAS) and quality of life (QoL) (assessed at the baseline, 1 week, 3 and 6 months) were compared between the two groups (L-PM and T-PM). RESULTS The implantation procedure was longer in L-PM than T-PM patients (42.2±16.3 vs. 28.9±11.9 minutes; p<0.001). L-PM was associated with lower intra- and post-operative pain intensity (all p<0.05), shorter hospitalization (3.2±0.5 vs. 3.5±1.1 days; p=0.034), greater patient acceptance (FPAS score: 58.7±7.1 vs. 40.5±4.1; p<0.001), and better QoL on both physical and mental health scales (all p<0.05). CONCLUSIONS Although L-PM implantation takes longer than T-PM, it is better tolerated and accepted by patients and is associated with a better QoL.
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Affiliation(s)
- Pietro Palmisano
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Alessandro Guido
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Vincenzo Panico
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | | | | | - Cesario Sergi
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | | | - Maria Zaccaria
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Michele Accogli
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
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12
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Mascheroni J, Mont L, Stockburger M, Patwala A, Retzlaff H, Gallagher AG. The imperative of consistency and proficiency in cardiac devices implant skills training. Open Heart 2021; 8:e001629. [PMID: 33972405 PMCID: PMC8112444 DOI: 10.1136/openhrt-2021-001629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jorio Mascheroni
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Lluís Mont
- Department of Cardiology, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Martin Stockburger
- Department of Cardiology and Internal Medicine, Havelland Kliniken, Nauen, Germany
- Department of Cardiology and Angiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ashish Patwala
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | | | - Anthony G Gallagher
- Orsi Academy, Melle, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Londonderry, UK
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13
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Oliveira SF, Carvalho MM, Adão L, Nunes JP. Clinical outcomes of leadless pacemaker: a systematic review. Minerva Cardiol Angiol 2020; 69:346-357. [PMID: 32657558 DOI: 10.23736/s2724-5683.20.05244-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Transvenous pacemakers are associated with a significant amount of complications. Leadless pacemakers (LP) are emerging as an alternative to conventional devices. This article provides a systematic review of patient eligibility, safety and clinical outcomes of the LP devices. EVIDENCE ACQUISITION A systematic search for articles describing the use of LP was conducted. Out of two databases, 24 articles were included in the qualitative analysis. These articles comprised a total of 4739 patients, with follow-up times of 1-38 months. Further information was obtained from 10 more studies. EVIDENCE SYNTHESIS From a population of 4739 patients included in the qualitative analysis, 4670 LP were implanted with success (98.5%). A total of 248 complications were described (5.23%) during the follow-up. The most common were pacing issues such as elevated thresholds, dislodgements or battery failure (68 patients), events at the femoral access site such as hemorrhage, hematoma or pseudoaneurysms (64 patients) and procedure related cardiac injuries such as cardiac perforation, tamponade or pericardial effusion (47 patients). There were 360 deaths during the follow-up and 11 were described as procedure or device related. Four studies presented the strategy of using a combined approach of atrioventricular node ablation (AVNA) and LP implantation. CONCLUSIONS Leadless pacemakers seem to have a relatively low complication rate. These devices may be a good option in patients with an indication for single-chamber pacing, in patients with conditions precluding conventional transvenous pacemaker implantations. Studies directly comparing LP and transvenous pacemakers and data on longer follow-up periods are needed.
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Affiliation(s)
| | - Miguel M Carvalho
- Faculty of Medicine, University of Porto, Porto, Portugal.,São João University Hospital, Porto, Portugal
| | - Luís Adão
- São João University Hospital, Porto, Portugal
| | - José P Nunes
- Faculty of Medicine, University of Porto, Porto, Portugal.,São João University Hospital, Porto, Portugal
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14
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Garweg C, Vandenberk B, Foulon S, Hermans P, Poels P, Haemers P, Ector J, Willems R. Determinants of the difficulty of leadless pacemaker implantation. Pacing Clin Electrophysiol 2020; 43:551-557. [DOI: 10.1111/pace.13933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Christophe Garweg
- Department of Cardiovascular SciencesUniversity of Leuven Leuven Belgium
- Department of CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Bert Vandenberk
- Department of Cardiovascular SciencesUniversity of Leuven Leuven Belgium
- Department of CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Stefaan Foulon
- Department of CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Patrick Hermans
- Department of CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Patricia Poels
- Department of CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Peter Haemers
- Department of Cardiovascular SciencesUniversity of Leuven Leuven Belgium
- Department of CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Joris Ector
- Department of Cardiovascular SciencesUniversity of Leuven Leuven Belgium
- Department of CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Rik Willems
- Department of Cardiovascular SciencesUniversity of Leuven Leuven Belgium
- Department of CardiologyUniversity Hospitals Leuven Leuven Belgium
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15
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Mohammed M, Arshi J, Ramza BM, Wimmer AP, Steinhaus DA, Giocondo MJ, Gupta SK, Yousuf OK. Outcomes using a single tapered dilator for Micra leadless pacemaker implant. Indian Pacing Electrophysiol J 2020; 20:105-111. [PMID: 32145397 PMCID: PMC7244861 DOI: 10.1016/j.ipej.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Comparison of outcomes, device deployment time (DT), and total time (TT) using a single tapered Coons dilator versus sequential serial dilation for implantation of the Micra leadless pacemaker. Background Micra leadless pacemaker placement requires a 23 French Micra introducer sheath (MIS) for percutaneous delivery. We sought to evaluate outcomes with use of a single tapered Coons dilator (CD) versus sequential serial dilatation (SD) method to facilitate insertion of the Micra introducer sheath. Methods 35 patients were included in the SD arm and 49 in the CD arm. DT and TT were recorded in minutes and cost in dollars. Analysis was performed using independent t-test between two groups and one-way ANOVA to evaluate inter-operator variability in the CD arm. Results Both DT and TT were significantly lower for the CD arm (15.1 ± 5.1 vs 23.5 ± 9.3, p < 0.0005 and 29.9 ± 14 vs 39.3 ± 13.5 min, p = 0.000374; respectively). The cost was also significantly lower using a CD versus SD. There was no inter-operator variability in the CD arm between 6 operators (p = 0.177 for DT and p = 0.304 for TT). No complications occurred in the SD arm. There were 3 vascular access site complications in the CD arm, all of which occurred early in the operator’s experience. Conclusion Coons dilator is an efficient and cost-effective method for vascular dilatation to facilitate Micra leadless pacemaker insertion. Rate of complications is low and expected to improve with greater experience.
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Affiliation(s)
- Moghniuddin Mohammed
- Department of Medicine, Saint Luke's Hospital, Kansas City, MO, USA; Department of Biomedical and Health Informatics, University of Missouri Kansas City, MO, USA
| | - Juwairiya Arshi
- Department of Medicine, Saint Luke's Hospital, Kansas City, MO, USA
| | - Brian M Ramza
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Alan P Wimmer
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Daniel A Steinhaus
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Michael J Giocondo
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Sanjaya K Gupta
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Omair K Yousuf
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
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16
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Beurskens NEG, Breeman KTN, Dasselaar KJ, Meijer AC, Quast AFBE, Tjong FVY, Knops RE. Leadless cardiac pacing systems: current status and future prospects. Expert Rev Med Devices 2019; 16:923-930. [DOI: 10.1080/17434440.2019.1685870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Niek E. G. Beurskens
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel T. N. Breeman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kosse J. Dasselaar
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A. Chris Meijer
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne-Floor B. E. Quast
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Fleur V. Y. Tjong
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinoud E. Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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17
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Della Rocca DG, Gianni C, Di Biase L, Natale A, Al-Ahmad A. Leadless Pacemakers: State of the Art and Future Perspectives. Card Electrophysiol Clin 2019; 10:17-29. [PMID: 29428139 DOI: 10.1016/j.ccep.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leadless pacemaker therapy is a new technology that aims at avoiding lead- and pocket-related complications of conventional transvenous and epicardial pacing. To date, 2 self-contained leadless pacemakers for right ventricular pacing have been clinically available: the Nanostim Leadless Pacemaker System and the Micra Transcatheter Pacing System. Additionally, a new multicomponent leadless pacemaker for endocardial left ventricular pacing has been proposed as an alternative choice for cardiac resynchronization therapy. In this review, we describe the state of the art of leadless pacing and compare the currently available devices with traditional transvenous leadless pacemakers.
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Affiliation(s)
- Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 720, Austin, TX 78705, USA.
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18
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Sperzel J, Hamm C, Hain A. Leadless pacing. Herz 2018; 43:605-611. [PMID: 30255304 DOI: 10.1007/s00059-018-4752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Leadless self-contained intracardiac pacemakers were developed with the aim of abolishing the short- and long-term risk of lead- and pocket-related complications associated with transvenous devices. Leadless pacemakers promise minimally invasive procedures, long battery lives, and small amounts of foreign materials in the body. Experiences with the pioneering single-chamber devices have provided reasons for optimism about the future of the leadless concept. In the future, as more patients receive and live longer with implantable devices, the total risk of procedure- and lead-related complications is expected to increase, adding a sense of urgency to the need for leadless alternatives to transvenous pacemakers. This review surveys the performance of currently available leadless pacemakers as well as emerging new innovative adaptations and applications of the leadless concept.
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Affiliation(s)
- J Sperzel
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany. .,Electrophysiology/Device Therapies, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Germany.
| | - C Hamm
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - A Hain
- Herzzentrum, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
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19
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Johar S, Luqman N. Initial experience with a leadless pacemaker (Micra™) implantation in a low volume center in South East Asia. Future Cardiol 2018; 14:389-395. [PMID: 30251546 PMCID: PMC6190239 DOI: 10.2217/fca-2017-0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim: The Micra™ Transcatheter Pacing System is a leadless pacemaker that has been introduced recently. We share our experience in a low volume center and the use of right ventricular angiography (RVA) during implantation. Materials & methods: Patients underwent Micra implantation and RVA was performed to predetermine the implant site. Results: Nine patients underwent Micra implantation. The most common indication was atrial fibrillation with bradycardia. The device was implanted at apical-septum in seven and mid-septum in two. The procedure time ranged from 30 to 100 min and fluoroscopic time 4–18 min. Pacing parameters remained stable after 1-month follow-up. Conclusion: The Micra implantation technique can be easily learnt. RVA was helpful in selecting an appropriate site for the Micra implant.
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Affiliation(s)
- Sofian Johar
- Consultant Cardiologist & Electrophysiologist, Gleneagles JPMC & Cardiac Centre RIPAS Hospital, Bander Seri Begawan BA1710, Brunei Darussalam
| | - Nazar Luqman
- Consultant Cardiologist, Cardiac Centre RIPAS Hospital, Bander Seri Begawan BA1710, Brunei Darussalam
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20
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Rossi L, Penela D, Doni L, Marazzi R, Napoli V, Napoli L, Vilotta M, Villani GQ, De Ponti R. Development of simulation combining a physical heart model and three-dimensional system for electrophysiology training. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1461-1466. [PMID: 30225923 DOI: 10.1111/pace.13508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/09/2018] [Accepted: 09/05/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND A new three-dimensional heart anatomical simulator (3D HAS) has been created combining a physical heart model with an electroanatomic mapping (EAM) system. The aim of this study is to describe the development and the validation process of this device. METHODS We developed the 3D HAS combining a physical heart model with an EAM system. This simulator was then validated by 10 electrophysiologists, subdivided in two groups based on their experience in electrophysiology procedures. The performance of the experts was compared to the one of the novices in achieving three different tasks: fluoroless reconstruction of the right atrium, coronary sinus cannulation, and deployment of a linear ablation lesion in the cavotricuspid isthmus. For each operator, a score was calculated based on objective parameter for each task and for the overall performance. RESULTS The 3D HAS was located in an environment that allowed use of the main features of the EAM system including contact force sensing. No technical issue was encountered during the validation process. The experts' performance was significantly better than the one of the novices both overall (P = 0.009) and in each task (right atrium reconstruction, P = 0.016; coronary sinus cannulation, P = 0.008; ablation lesion, P = 0.03). CONCLUSIONS The 3D HAS is reliable and allows use of the main features of an EAM system in the right atrium. The ability to discriminate different levels of experience suggests that this simulator is enough realistic and could be useful for electrophysiology training.
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Affiliation(s)
- Luca Rossi
- Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Diego Penela
- Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Lorenzo Doni
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi-University of Insubria, Varese, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi-University of Insubria, Varese, Italy
| | - Velia Napoli
- Biosense Webster, Johnson & Johnson Medical S.p.A., Pomezia, Italy
| | | | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi-University of Insubria, Varese, Italy
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi-University of Insubria, Varese, Italy
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21
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The learning curve associated with the implantation of the Nanostim leadless pacemaker. J Interv Card Electrophysiol 2018; 53:239-247. [PMID: 30105428 PMCID: PMC6182715 DOI: 10.1007/s10840-018-0438-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/03/2018] [Indexed: 12/03/2022]
Abstract
Purpose Use of novel medical technologies, such as leadless pacemaker (LP) therapy, may be subjected to a learning curve effect. The objective of the current study was to assess the impact of operators’ experience on the occurrence of serious adverse device effects (SADE) and procedural efficiency. Methods Patients implanted with a Nanostim LP (Abbott, USA) within two prospective studies (i.e., LEADLESS ll IDE and Leadless Observational Study) were assessed. Patients were categorized into quartiles based on operator experience. Learning curve analysis included the comparison of SADE rates at 30 days post-implant per quartile and between patients in quartile 4 (> 10 implants) and patients in quartiles 1 through 3 (1–10 implants). Procedural efficiency was assessed based on procedure duration and repositioning attempts. Results Nanostim LP implant was performed in 1439 patients by 171 implanters at 60 centers in 10 countries. A total of 91 (6.4%) patients experienced a SADE in the first 30 days. SADE rates dropped from 7.4 to 4.5% (p = 0.038) after more than 10 implants per operator. Total procedure duration decreased from 30.9 ± 19.1 min in quartile 1 to 21.6 ± 13.2 min (p < 0.001) in quartile 4. The need for multiple repositionings during the LP procedure reduced in quartile 4 (14.8%), compared to quartiles 1 (26.8%; p < 0.001), 2 (26.6%; p < 0.001), and 3 (20.4%; p = 0.03). Conclusions Learning curves exist for Nanostim LP implantation. Procedure efficiency improved with increased operator experience, according to a decrease in the incidence of SADE, procedure duration, and repositioning attempts. Electronic supplementary material The online version of this article (10.1007/s10840-018-0438-8) contains supplementary material, which is available to authorized users.
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22
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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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