Anatomical location of leadless pacemaker and the risk of pacing‐induced cardiomyopathy

Shantha, Ghanshyam Palamaner Subash; Brock, Jonathan; Singleton, Matthew J.; Kozák, P; Bodziock, George; Bradford, Natalie; Deshmukh, Abhishek; Liang, Jackson J.; Pothineni, Naga Venkata K.; Hranitzky, Patrick; Whalen, Patrick; Bhave, Prashant D.

doi:10.1111/jce.15925

Cited by 13 publications

(6 citation statements)

References 19 publications

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“…Additionally, the preferential mid to high septal location of LP, which was the reported implant location in 65% of patients in this cohort, has been associated with a lower risk of PICM. 16 …”

Section: Discussionmentioning

confidence: 99%

Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry

El-Chami,

Garweg,

Clementy

et al. 2024

European Heart Journal

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Background and Aims Prior reports have demonstrated a favourable safety and efficacy profile of the Micra leadless pacemaker over mid-term follow-up; however, long-term outcomes in real-world clinical practice remain unknown. Updated performance of the Micra VR leadless pacemaker through five years from the worldwide post-approval registry (PAR) was assessed. Methods All Micra PAR patients undergoing implant attempts were included. Endpoints included system- or procedure-related major complications and system revision rate for any cause through 60 months post-implant. Rates were compared through 36 months post-implant to a reference dataset of 2667 transvenous pacemaker patients using Fine–Gray competing risk models. Results 1809 patients were enrolled between July 2015 and March 2018 and underwent implant attempts from 179 centres in 23 countries with a median follow-up period of 51.1 months (IQR: 21.6–64.2). The major complication rate at 60 months was 4.5% [95% confidence interval (CI): 3.6%–5.5%] and was 4.1% at 36 months, which was significantly lower than the 8.5% rate observed for transvenous systems (HR: .47, 95% CI: .36–.61; P < .001). The all-cause system revision rate at 60 months was 4.9% (95% CI: 3.9%–6.1%). System revisions among Micra patients were mostly for device upgrades (41.2%) or elevated thresholds (30.6%). There were no Micra removals due to infection noted over the duration of follow-up. At 36 months, the system revision rate was significantly lower with Micra vs. transvenous systems (3.2% vs. 6.6%, P < .001). Conclusions Long-term outcomes with the Micra leadless pacemaker continue to demonstrate low rates of major complications and system revisions and an extremely low incidence of infection.

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Section: Discussionmentioning

confidence: 99%

Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry

El-Chami,

Garweg,

Clementy

et al. 2024

European Heart Journal

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“…Older studies including BLOCK‐HF predominately used RV apical pacing whereas the majority in our study utilized mid‐septal pacing. There are mixed results on whether RV pacing site affects the incidence of PICM 4,5,12 …”

Section: Discussionmentioning

confidence: 99%

“…There are mixed results on whether RV pacing site affects the incidence of PICM. 4,5,12 Another difference may be the impact that medical therapy, particularly beta blockade, has on LV function. Kim et al reported that patients with normal LV functions who were on beta blockers after implantation of a PPM were more likely to develop PICM while we found that the presence and treatment with beta blockers was not associated with worsening LV function.…”

Section: T a B L Ementioning

confidence: 99%

Correlation of ventricular pacing burden and left ventricular function in patients with heart failure with reduced ejection fraction

Scully,

Kelsang,

Backhouse

et al. 2023

Cardiovasc electrophysiol

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BackgroundPacemaker‐induced cardiomyopathy is a well described phenomenon in patients with preserved ejection fraction at the time of permanent pacemaker implant. One of the identified risk factors for pacemaker‐induced cardiomyopathy is the degree of ventricular pacing burden. However, it is unclear how a high right ventricular pacing burden affects patients with depressed left ventricular function at the time of pacemaker implantation. We sought to assess the relationship between right ventricular pacing and change in left ventricular function over time.MethodsWe conducted an analysis of all patients who had received either a single or dual lead cardiac implantable electronic devices, excluding biventricular devices, and had a prior transthoracic echocardiogram demonstrating an ejection fraction of less than 50%. The primary end‐point was the correlation between the percentage of ventricular pacing and the change in LV ejection fraction.ResultsFifty eight patients with preceding heart failure had pacemakers implanted and had follow up echocardiograms. There was no correlation between the degree of ventricular pacing and the absolute change in LV function (r = .04, p = .979). None of the previously identified risk factors for pacemaker induced cardiomyopathy were predictive of a significant fall in ejection fraction.ConclusionThe degree of RV pacing and other established risk factors for pacemaker‐induced cardiomyopathy in patients with normal left ventricular function at the time of implantation do not appear to carry the same risk in patients with pre‐existing heart failure who receive either single or dual lead pacemakers.

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“…In this issue of the Journal of Cardiovascular Electrophysiology, Shantha et al 10 were positioned in the HS. Patient characteristics, including cardiovascular comorbidities and baseline LVEF were largely similar in both groups.…”

mentioning

confidence: 99%

“…Anatomic location of leadless pacemaker and pacing-induced cardiomyopathy. Depicted is an overview of key findings of the Shantha et al10 study as well as potential contributing factors to the observation of lower incidence of pacing-induced cardiomyopathy with leadless pacemaker implant in a mid/high septal position (left) compared with an apical septal/ apical position (right).…”

mentioning

confidence: 99%

Pacing‐induced cardiomyopathy after leadless pacemaker implant: It's all about location, location, location

Pipilas

Frankel

Khurshid

2023

Cardiovasc electrophysiol

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Anatomical location of leadless pacemaker and the risk of pacing‐induced cardiomyopathy

Cited by 13 publications

References 19 publications

Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry

Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry

Correlation of ventricular pacing burden and left ventricular function in patients with heart failure with reduced ejection fraction

Pacing‐induced cardiomyopathy after leadless pacemaker implant: It's all about location, location, location

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