Leadless pacemaker implantation: A feasible and reasonable option in transcatheter heart valve replacement patients

Abstract

Background: Leadless pacemakers (LPMs) have been shown to have lower postoperative complications than traditional permanent pacemakers but there have been no studies on the outcomes of LPMs in patients with transcatheter heart valve replacements (THVRs). This study determined outcomes of LPMs compared to transvenous single-chamber pacemakers (SCPs) post-THVR.Methods: This is a retrospective single-center study including 10 patients who received LPMs post-THVR between February 2017 and August 2018 and a comparison group of 23 patients who received SCP post-THVR between July 2008 and August 2018. LPM or SCP was implanted at the discretion of electrophysiologists for atrial fibrillation with slow ventricular response or sinus node dysfunction with need for single-chamber pacing only.Results: LPMs were associated with decreased tricuspid regurgitation (P = 0.04) and decreased blood loss during implantation (7.5 ± 2.5 cc for LPMs vs 16.8 ± 3.2 cc for SCPs, P = 0.03). Five LPM patients had devices positioned in the right ventricular septum as seen on transthoracic echocardiogram. Frequency of ventricular pacing was similar between LPM and SCP groups. In the LPM group, one case was complicated by a pseudoaneurysm and one death was due to noncardiac causes. There was one pneumothorax and one pocket infection in the SCP group. Conclusions:In this small retrospective study, LPMs were feasible post-THVR and found to perform as well as SCPs, had less intraprocedural blood loss, and were associated with less tricuspid regurgitation. Further, larger studies are required to follow longer-term outcomes and complications. K E Y W O R D Sleadless pacemaker, permanent pacemaker, single-chamber pacemaker, transcatheter heart valve replacement, tricuspid regurgitation 542

Evolution of tricuspid valve regurgitation after implantation of a leadless pacemaker: A single center experience, systematic review, and meta‐analysis

“…Eighty-two studies were further examined in full text, and seven met the pre-specified inclusion criteria (Figure 2). 8,9,11,12,[16][17][18]…”

Leadless pacemaker for patients following cardiac valve intervention

“…Previously, Moore et al compared the outcomes between leadless pacing in 10 patients and conventional single-chamber pacing in 23 patients after TAVI. The authors found that the leadless pacemaker performed as well as conventional pacemaker and was associated with less tricuspid regurgitation and less bleeding during the implant procedure [24].…”

One-year pacing dependency after pacemaker implantation in patients undergoing transcatheter aortic valve implantation: Systematic review and meta-analysis

“…17,27 According to these findings, we should emphasize that patients without baseline characteristics potentially leading to pacemaker dependency should benefit from other temporary leadless system as Micra AV (Medtronic, Minneapolis, Minn) to reduce the rate of permanent pacemaker implanted, as the Micra AV system is recently found to be safe; efficient and as performant as transvenous single-chamber pacemaker. 32,33 Nowadays, guidelines regarding timing of PPI after TAVI are rather cloudy and not based on thorough clinical investigations. 8,34 Due to the lack of consistent data, the dilemma about the appropriate timing for pacemaker implantation after TAVI is left to the discretion of the attending cardiologist according to the different centers' policies and therefore is associated with extreme variability in clinical management.…”