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Doshi RN, Kleinhans AC. A broken tine as a possible explanation for rise in pacing threshold in a leadless pacemaker. HeartRhythm Case Rep 2023; 9:573-575. [PMID: 37614395 PMCID: PMC10444565 DOI: 10.1016/j.hrcr.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Rahul N. Doshi
- HonorHealth Cardiac Arrhythmia Group, Scottsdale, Arizona
- University of Arizona College of Medicine Phoenix, Phoenix, Arizona
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Nakamura T, Fukuzawa K, Kiuchi K, Takami M, Hirata KI. Leadless pacemaker: Should repositioning be needed despite a good threshold? Indian Pacing Electrophysiol J 2023; 23:130-132. [PMID: 37060993 PMCID: PMC10323175 DOI: 10.1016/j.ipej.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/04/2023] [Accepted: 04/08/2023] [Indexed: 04/17/2023] Open
Affiliation(s)
- Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Togashi I, Sato T, Akiko Maeda NP, Mohri T, Katsume Y, Tashiro M, Momose Y, Nonoguchi N, Hoshida K, Miwa Y, Ueda A, Soejima K. Fluoroscopic Predictors of Acceptable Capture threshold during the Implantation of the Micra Transcatheter Pacing System. J Cardiovasc Electrophysiol 2022; 33:1255-1261. [PMID: 35304791 PMCID: PMC9315022 DOI: 10.1111/jce.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Introduction Few predictors of low capture threshold before the deployment of the Micra transcatheter pacing system (Micra TPS) have been determined. We aimed to identify fluoroscopic predictors of an acceptable capture threshold before Micra TPS deployment. Methods Sixty patients were successfully implanted with Micra TPS. Before deployment, gooseneck appearance of the catheter shaft was quantified using the angle between the tangent line of the shaft and the cup during diastole in the right anterior oblique (RAO) view. The direction of the device cup toward the ventricular septum was evaluated using the angle between the cup and the horizontal plane in the left anterior oblique (LAO) view. Results Of the 95 deployments we evaluated, 56 achieved an acceptable capture threshold of ≤2.0 V at 0.24 ms. In this acceptable threshold group, the deflection angle of the gooseneck shaft was significantly larger and the device cup was placed more horizontally with a lower elevation angle compared with those in the high threshold group. A deflection angle of ≥6° and an elevation angle of ≤30° were identified as the predictors of an acceptable capture threshold after deployment. An acceptable capture threshold was achieved in 24/31 (77.4%) patients in whom either angle criterion was satisfied at the first deployment. Conclusions Diastolic gooseneck appearance of the delivery catheter in the RAO view or near‐horizontal direction in the LAO view predicts an acceptable capture threshold after deployment. The shape of the delivery catheter before deployment should be evaluated using multiple fluoroscopic views to ensure successful implantation of Micra TPS.
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Affiliation(s)
- Ikuko Togashi
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka, Japan
| | - Toshiaki Sato
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka, Japan
| | - N P Akiko Maeda
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Takato Mohri
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yumi Katsume
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Mika Tashiro
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yuichi Momose
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Noriko Nonoguchi
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Hoshida
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yosuke Miwa
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Soejima
- Division of Cardiology, the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
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