ICD remote monitoring can potentially diagnose >99.5% of arrhythmia- or device-related problems if combined with clinical follow-up by the local general practitioner and/or referring cardiologist. It may provide a way to significantly reduce in-office follow-up visits that are a burden for both hospitals and patients.

Background With its steerable transcatheter delivery system, the Micra can be deployed in nonapical positions within the right ventricle, potentially allowing reduction of the paced QRS width. We sought to evaluate the safety and long‐term performance of the right ventricular outflow tract (RVOT) pacing using the Micra transcatheter pacing system (TPS). We also compared the paced QRS between RVOT, mid‐septal, and apical implant positions. Methods All patients who underwent a Micra TPS implantation at the University Hospitals of Leuven were enrolled in this observational study. Right ventricular (RV) position of the device was assessed on per‐procedural ventriculography. Paced QRS was analyzed and follow‐up completed at 1 month and then every 6 months. Results Among the 133 patients included (mean follow‐up: 13 ± 11 months), 45 were implanted in the RVOT, 58 midseptally, and 30 at the apex. All implant procedures were successful and no pericardial effusion was encountered within the 30 days post‐implant. Two major complications were reported with devices implanted at the apex. Pacing impedance was significantly higher in the RVOT compared to the mid‐septal and apical position (P < .001). Pacing threshold and R‐wave amplitude did not differ over time in either position. The median narrowest paced QRS duration was observed in the RVOT (142 ms) compared to mid‐septal (159 ms; P < .001), and apical position (181 ms; P < .001). Conclusion Implantation of the Micra TPS in the RVOT is safe and feasible. Electrical performance over time was comparable to mid‐septal and apical positions. The narrowest paced QRS complexes is achieved with RVOT pacing.

Background: Permanent pacing is common after valve intervention. The presence of conventional pacemaker in this population is recognized as risk factor for infectious event. Therefore, a leadless pacing system could be the preferred strategy when permanent pacing is required after valve intervention. We report peri-procedural outcomes and follow-up of patients undergoing the implantation of a leadless pacing system after valve intervention.Methods: Patients with previous valve intervention at the time of leadless pacemaker (Micra, Medtronic) implant attempt were included and compared to a control group (patients also implanted with Micra without valve intervention).Results: Of a total of 170 Micra implant procedures, 54 (31.8%) patients had a history of valve intervention: 28 after AVR, 10 after MVR, 1 after single tricuspid valvuloplasty and 15 after multiple valve surgery. Patients were 82.5 (77.0-86.0) years old and 53.7% were male. Patients with previous valve intervention had a higher incidence of arterial hypertension (p=0.014) and ischemic heart disease (p=0.040). Primary indication for permanent pacing after valve intervention was high degree AV block (59.3%) or AF with bradycardia (27.8%). Micra was successfully implanted in all patients (n=170) without any procedure-related major complications. During a median follow-up of 12 months, electrical performance was excellent and comparable in both groups. Also, a similar LVEF reduction was observed at 12 months in both groups that was correlated with the percentage of right ventricular pacing. Conclusion:Leadless pacemaker is safe and efficient after valve intervention and represents therefore an effective pacing option in patients after valve intervention.

Our experience confirms that implantation of Micra is safe and efficient in a real world population including patients who present a challenging condition for conventional pacing.

Background The Micra Transcatheter Pacing System is implanted directly in the right ventricle (RV) through the femoral vein using a steerable transcatheter delivery system. The present study was done to identify determinants of difficult leadless pacemaker implant procedures including operator, patient, and RV anatomical characteristics. Methods All patients who underwent a Micra implant from July 2015 to December 2018 at our center were analyzed. From an RV angiogram acquired during implantation, RV geometry including systolic and diastolic volumes and ejection fraction was characterized. The presence of septomarginal trabeculation was noted. Results One hundred twenty‐six patients (mean age: 79 ± 11 years old, mostly male: 77%) were enrolled. Mean Micra RV implant procedure time was 24 ± 23 min, with 1.7 ± 1.3 deployments of the device. No significant change in implant procedure time was observed after the first 30 implants. Eleven patients had a prominent septal component of the septomarginal trabeculation in the RV. Univariate analysis showed that the procedure time was positively correlated with the presence of a prominent septal component of the septomarginal trabeculation (P < .001) or an episode of heart failure (P = .02) and negatively correlated with the number of procedures performed by the operator (P < .001). After multivariable analysis, only the presence of a prominent septal component of the septomarginal trabeculation (P < .001) and the number of procedures performed by the operator (P < .001) were associated with the implant procedure time. Conclusions In our experience, implant procedure time of a Micra leadless pacemaker depended on the presence of a prominent septal component of the septomarginal trabeculation and operator experience.