Beyond the Wires: A Case of Leadless Pacemaker–Mediated Tricuspid Regurgitation

Cirne, Filipe; Salehian, Omid; Wright, Douglas

doi:10.1016/j.case.2021.06.003

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…7 Finally, while case reports exist describing acute TR following implant-related mechanical trauma, it remains to be determined whether the majority of cases of worsening TR are a result of implant-related damage or chronic tension on the valve apparatus as a result of leaflet interaction or pacing-induced dyssynchrony. [11][12][13] Of note, those cohorts with the shortest echocardiographic follow up interval also reported the lowest incidence of progressive TR, suggesting a chronic component to this phenomenon. 8 Nonetheless, a significant propor- pacemaker implant with a mean reduction in LVEF of 3.2%.…”

Section: Valvular Functionmentioning

confidence: 90%

Association of leadless pacing with ventricular and valvular function

Arps,

Li,

Allen

et al. 2023

Cardiovasc electrophysiol

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BackgroundTraditional transvenous pacemakers are associated with worsening tricuspid valve function due to lead‐related leaflet impingement, as well as ventricular dysfunction related to electromechanical dyssynchrony from chronic right ventricular (RV) pacing. The association of leadless pacing with ventricular and valvular function has not been well established. We aimed to assess the association of leadless pacemaker placement with changes in valvular regurgitation and ventricular function.Methods and ResultsEchocardiographic features before and after leadless pacemaker implant were analyzed in consecutive patients who received a leadless pacemaker with pre‐ and postprocedure echocardiography at Duke University Hospital between November 2014 and November 2019. Valvular regurgitation was graded ordinally from 0 (none) to 3 (severe). Among 54 patients, the mean age was mean age was 70.1 ± 14.3 years, 24 (44%) were women, and the most frequent primary pacing indication was complete heart block in 24 (44%). The median RV pacing burden was 45.4 (interquartile range [IQR] 3.5–97.0). On echocardiogram performed 8.9 months (IQR 4.5–14.5) after implant, there was no change in the average severity of tricuspid regurgitation (mean change 0.07 ± 1.15, p = .64) from pre‐procedure echocardiogram. We observed a decrease in the average left ventricular ejection fraction (LVEF) (52.3 ± 9.3 to 47.9 ± 12.1, p = .0019) and tricuspid annular plane systolic excursion (TAPSE) (1.8 ± 0.6 to 1.6 ± 0.4, p = .0437). Thirteen patients (24%) had absolute drop in LVEF of ≥10%.ConclusionWe did not observe short term worsening valvular function in patients with leadless pacemakers. However, consistent with the pathophysiologic impact of RV pacing, leadless pacing was associated with a reduction in biventricular function.

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Section: Valvular Functionmentioning

confidence: 90%

Association of leadless pacing with ventricular and valvular function

Arps,

Li,

Allen

et al. 2023

Cardiovasc electrophysiol

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The Micra Transcatheter Pacing System: Past, Present and the Future

Toon,

Roberts

2023

Future Cardiol.

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Leadless permanent pacemakers represent an important innovation in cardiac device developments. Although transvenous permanent pacemakers have become indispensable in managing bradyarrhythmia and saving numerous lives, the use of transvenous systems comes with notable risks tied to intravascular leads and subcutaneous pockets. This drawback has spurred the creation of leadless cardiac pacemakers. Within this analysis, we compile existing clinical literature and proceed to evaluate the efficacy and safety of the Micra Transcatheter Pacing System. We also delve into the protocols for addressing a malfunctioning or end-of-life Micra as well as device extraction. Lastly, we explore prospects in this domain, such as the emergence of entirely leadless cardiac resynchronization therapy-defibrillator devices.

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Beyond the Wires: A Case of Leadless Pacemaker–Mediated Tricuspid Regurgitation

Abstract: Graphical abstract

Cited by 2 publications

References 12 publications

Association of leadless pacing with ventricular and valvular function

Association of leadless pacing with ventricular and valvular function

The Micra Transcatheter Pacing System: Past, Present and the Future

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