Leadless pacemaker implantation in patients with a previous transvenous device

Abstract

Funding Acknowledgements Type of funding sources: None. Background Leadless pacing has been established as an alternative approach to transvenous devices for selected patients suffering from bradycardias. While in the majority of cases leadless pacemaker implantation represents a de novo procedure, in an increasing number of patients such a device is used after a previously implanted transvenous pacemaker. Purpose Retrospective analysis of the efficacy and safety outcome in patients who underwent leadless pacemaker implantation in the context of a previously implanted conventional pacemaker. Methods and Results In this retrospective analysis from two large Swiss implantation centres, 257 consecutive patients undergoing leadless pacemaker implantation were included. Of the total cohort, 233 patients were diagnosed with new-onset bradycardias, while in 24 patients a prior transvenous device was present. Out of these 24 patients, 20 subjects required lead extraction of the previous system due to infection (70%, 14 patients), malfunction or other reasons (Table 1). In 3 patients with device-related infection, lead extraction and leadless pacemaker implantation were performed as a single procedure, while in the remaining 11 cases a time window between the two procedures was present (median of 11.5 days with a range of 2 to 186 days). In the population with a previous device, mean age at implantation was 81 ± 9 years which did not differ compared to the de novo cohort. Mean implantation duration was 57 ± 31 minutes in the cohort with a previous device versus 48 ± 191 minutes in the de novo population without a significant difference (P=NS) and with a successful implantation rate of 100% versus 98.7% in the de novo population (P=NS). Electrical device parameters (sensing, impedance, threshold) at implantation and during follow-up (mean 12.5 ± 9.3 months) were similar between the two groups. Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 femoral bleedings and 1 intra-abdominal bleeding) in the entire cohort within a 30 days period, of which the majority occurred in the de novo cohort (75 %, 6 of 8). A total of 4 pericardial effusions occurred, which could be managed without the need for cardiac surgery. The were no reinfections registered after leadless pacemaker implantation during follow-up. Conclusions Implantation of a leadless pacemaker in patients with a prior conventional system (with or without extraction of the previous device) was effective and safe in our population of patients.