A leadless pacemaker matched with a vasovagal syncope: how long can it last?

Abstract

Background Guidelines recommend that cardiac pacing should be considered in patients suffering from frequent vasovagal syncopal (VVS) episodes. Studies have demonstrated the safety and efficacy of leadless pacemakers (LP) in cardioinhibitory vasovagal populations specifically, rendering them a reasonable alternative to transvenous pacing in these patients. However, due to the paucity of data on extraction and the number of concomitant LPs that can be safely implanted, there are concerns regarding LPs’ battery longevity, especially in younger patients who may require decades of pacing therapy. Methods This is a retrospective analysis of the first 100 LPs implanted at a tertiary cardiac centre in the UK. Demographical data and device parameters at implant and follow‐ups were obtained from the hospital's medical records. The battery life of the LPs in the VVS patients was compared to that of patients with other pacing indications. Results Ninety patients were included in the analysis. 14 patients (15.6%) had VVS, and 76 patients (84.4%) had other indications for pacing. Mean ages were 34 ± 13 years and 62 ± 20 years for the VVS and the other group, respectively. The estimated total battery life was 15.22 ± 0.35 and 13.65 ± 2.97 years in the VVS and the other indications group respectively (p = .04). There were no complications in the VVS group. Conclusion LPs provide a promising treatment for patients with vasovagal syncope with reassuring battery performance at the short/intermediate term. Further longer‐term follow‐up data are needed to identify the true battery potential in this patient cohort.

Transcatheter Leadless Pacemaker for the Treatment of Vasovagal Syncope

“…No adverse events were noted in the VVS group. 7 End-of-life management of leadless pacemaker systems includes either placing an additional leadless device adjacent to the abandoned pacemaker. Given the small size and volume of the leadless pacemaker systems, device–device-related adverse events and interactions are unlikely.…”

“…In 1 study, the pacing percentage for VVS patients was 1% ± 1%, significantly less than the average pacing percentage of 37% ± 43% in patients with other indications for pacing. 7…”

“…In 1 study, the pacing percentage for VVS patients was 1% ± 1%, significantly less than the average pacing percentage of 37% ± 43% in patients with other indications for pacing. 7 The data on leadless pacemaker systems with right ventricular pacing for the treatment of VVS remains limited but effective and safe. In addition to the Micra leadless pacemaker system, the Aveir leadless pacemaker system was the second device on the market in the United States to be Food and Drug Administration approved in 2022.…”