Leadless pacemaker implantations after infectious pacemaker removals in octogenarians

Abstract

Background: Management of pacemaker (PM) infections in patients with an advanced age is one of the most sensitive issues, since they possess particular clinical challenges due to higher rates of medical comorbidities. The novel leadless pacemaker (LP) requiring no transvenous lead or device pocket, may provide new opportunities for the management of PM infections among patients with an advanced age. Methods: We reviewed 8 octogenarians (median age of 86 [minimum 82-maximum 90], male 63%) who received an LP implantation following a transvenous lead extraction (TLE) of an infectious PM. Results: All patients had more than 2 medical comorbidities. The indications for the LP implantations were atrioventricular block in 3 patients, atrial fibrillation bradycardia in 3, and sinus node dysfunction in 2. Five patients were bridged with a temporary pacing using an active fixation lead (median interval of 14.5 days), while one patient with severe dementia underwent a concomitant LP implantation and TLE during the same procedure. Successful TLEs and LP implantations were accomplished in all patients. There were no major or minor complications including vascular access troubles. All patients were discharged 2-8 days after the implantation. All patients stayed free of infection during the follow-up period of 6 months Conclusions: LP implantations were safe and effective after infected pacemaker removals in all 8 octogenarians. The novel LP technology may offer an alternative option in considering re-implantation of a PM even among patients with an advanced age and who are PM dependent.

EHRA expert consensus document on the management of arrhythmias in frailty syndrome, endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA)

“…These features make leadless pacing an attractive option for older and frail patients in need of a pacemaker. 81 , 82 …”

Management of a patient with multiple device replacements and extractions: When the leadless pacemaker is a viable solution

“…Nevertheless, Zucchelli et al., showed that a Micra implant is feasible and safe, even in patients who previously underwent device extraction, and there are no significant differences in implanting a Micra after extraction or as first line pacing therapy 8 . In our case, awaiting permanent PM, to avoid symptomatic junctional bradycardia we placed an epicardial lead, but previous studies showed the feasibility of a LPs even with an intracardiac temporary pacing lead 6,9–12 . The presence of a lead screwed in the right ventricle may affect the maneuverability of the delivery system.…”

“…8 In our case, awaiting permanent PM, to avoid symptomatic junctional bradycardia we placed an epicardial lead, but previous studies showed the feasibility of a LPs even with an intracardiac temporary pacing lead. 6,[9][10][11][12] The presence of a lead screwed in the right ventricle may affect the maneuverability of the delivery system. However, the safety and the acute success rate seemed not to be compromised.…”

Leadless Pacemaker Infection Risk in Patients with Cardiac Implantable Electronic Device Infections: A Case Series and Literature Review

“…Additionally, 11 (55%) patients had positive lead cultures. Antimicrobial therapy was administered for a median time of 27 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] days after LP placement. The most common administered antimicrobial was daptomycin in 60% of cases.…”