Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

Abstract

Background The feasibility and outcomes of concomitant atrioventricular node ablation (AVNA) and leadless pacemaker implant are not well studied. We report outcomes in patients undergoing Micra implant with concomitant AVNA. Methods Patients undergoing AVNA at the time of Micra implant from the Micra Transcatheter Pacing (IDE) Study, Continued Access (CA) study, and Post‐Approval Registry (PAR) were included in the analysis and compared to Micra patients without AVNA. Baseline characteristics, acute and follow‐up outcomes, and electrical performance were compared between patients with and without AVNA during the follow‐up period. Results A total of 192 patients (mean age 77.4 ± 8.9 years, 72% female) underwent AVNA at the time of Micra implant and were followed for 20.4 ± 15.6 months. AVNA patients were older, more frequently female, and tended to have more co‐morbid conditions compared with non‐AVNA patients (N = 2616). Implant was successful in 191 of 192 patients (99.5%). The mean pacing threshold at implant was 0.58 ± 0.35 V and remained stable during follow‐up. Major complications within 30 days occurred more frequently in AVNA patients than non‐AVNA patients (7.3% vs. 2.0%, p < .001). The risk of major complications through 36‐months was higher in AVNA patients (hazard ratio: 3.81, 95% confidence interval: 2.33–6.23, p < .001). Intermittent loss of capture occurred in three AVNA patients (1.6%), all were within 30 days of implant and required system revision. There were no device macrodislodgements or unexpected device malfunctions. Conclusion Concomitant AVN ablation and leadless pacemaker implant is feasible. Pacing thresholds are stable over time. However, patient comorbidities and the risk of major complications are higher in patients undergoing AVNA.

Atrioventricular synchronous leadless pacing: Micra AV

“…Micra’s implantation safety, performance, and post-procedural complications were also evaluated in a retrospective study comparing patients with pre-procedure AV-node ablation (AVNA). The study proved the procedural and performance safety of concomitant AVNA and LP implantation with the precaution of a higher risk of major complications in patients undergoing AVNA [ 24 ].…”

The jugular approach for leadless pacing: A novel and safe alternative

“…Patients requiring an AV node ablation did not receive this concomitant to the leadless pacemaker implantation. The leadless pacemaker was implanted at least 4 weeks prior to the AV node ablation 14 …”

Leadless Pacemakers: State of the Art and Selection of the Ideal Candidate

“…Additionally, patients with sinus node dysfunction with limited ventricular pacing needs or tachycardia-bradycardia syndrome with post-conversion pauses are reasonable candidates for ventricular-only pacing. A one-stage treatment for AF with poorly controlled rates with an LP placement and atrioventricular node ablation through the femoral access site has been feasible and safe [ 42 ].…”