Micra pacemaker implant after cardiac implantable electronic device extraction: feasibility and long-term outcomes

Zucchelli, Giulio; Barletta, Valentina; Tommasina, Veronica Della; Viani, Stefano; Parollo, M; Mazzocchetti, L; Cellamaro, T; Paperini, Luca; Cori, Andrea Di; Lucia, R De; Segreti, Luca; Soldati, Ezio; Bongiorni, Maria Grazia

doi:10.1093/europace/euz160

Cited by 27 publications

(15 citation statements)

References 16 publications

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“…Likewise, feasibility and electrical performance of M-TPS in a patients population previously undergone to a transvenous lead extraction (TLE) procedure has clearly been discussed [15]. All data suggested that technical complexity of the implant procedure was similar in both patient groups, those underwent TLE and those who received M-TPS has first pacing option, in terms of fluoroscopy time and number of device deployments.…”

Section: Leadless Pacing: Safety Firstmentioning

confidence: 99%

Leadless pacing in the elderly: never too old for something new

Barletta

Zucchelli

Parollo

et al. 2020

Monaldi Arch Chest Dis

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Rates of cardiac pacemaker implantation rise with age, and, meanwhile, elderly patient may be at great risk of complications, as pneumothorax, lead perforation, or pocket dehiscence. The use of leadless pacemaker could overcome peri- and post-procedural complications related to the presence of transvenous leads and pocket. The study aims to investigate feasibility and outcomes of Micra Transcatheter Pacing System (M-TPS) implantation in elderly, which represents a challenge for conventional cardiac pacing. Between May 2014 and July 2019, 109 patients (88 males, mean age 77.71±9.68 years) underwent M-TPS implantation at our Center, targeting a non-apical site of delivery when feasible. Study population was divided into two groups according to age (group 1 <79 years vs group 2 group 2 ≥80 years). The outcome evaluation included electrical performance at hospital discharge, and during follow-up. In 46/109 cases (34 males, 73.91%) M-TPS was implanted in patients older than 80 years. There were no statistically significant differences between groups for demographics characteristics, except for age. The procedure was performed via the right femoral access in 102/109 cases and was successful in all cases, with no device-related events. No differences were observed between groups in procedure duration, single device delivery, electrical performance at implant and at 12 month F-U. MTP-S implant is an effective and safe procedure in elderly patients, with similar electrical performance and outcome compared with younger patients at mid-term follow-up.

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Section: Leadless Pacing: Safety Firstmentioning

confidence: 99%

Leadless pacing in the elderly: never too old for something new

Barletta

Zucchelli

Parollo

et al. 2020

Monaldi Arch Chest Dis

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“…In addition, device encapsulation might be protective against bacterial infiltration. The parylene coating of the Micra TPS might also play a role in reducing bacterial adherence 21 . Finally, the turbulent blood flow at the site of Micra TPS might reduce the opportunity of bacterial infection.…”

Section: Discussionmentioning

confidence: 99%

Life cycle management of Micra transcatheter pacing system: Data from a high‐volume center

Kiani

Merchant

Delurgio

et al. 2020

Cardiovasc electrophysiol

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Background Data on the management of Micra transcatheter pacing system (TPS) at the time of an upgrade or during battery depletion is limited. Objective We sought to evaluate the management patterns of patients implanted with a Micra TPS during long‐term follow‐up. Methods We retrospectively identified patients who underwent Micra implantation from April 2014 to November 2019. We identified patients who underwent extraction (n = 11) or had an abandoned Micra (n = 12). Results We identified 302 patients who received a Micra during the period of the study. Mean age was 72.7 ± 15.4 years, 54.6% were men, and left ventricular ejection fraction was 51.9 ± 5.2%. Mean follow‐up was 1105.5 ± 529.3 days. Procedural complications included pericardial tamponade (n = 1) treated with pericardiocentesis, significant rise in thresholds (n = 6) treated with reimplantation (n = 4), and major groin complications (n = 2). Indications for extraction included an upgrade to cardiac resynchronization therapy (CRT) device (n = 3), bridging after extraction of an infected transvenous system (n = 3), elevated thresholds (n = 3), and non‐Micra‐related bacteremia (n = 2). The median time from implantation to extraction was 78 days (interquartile range: 14–113 days), with the longest extraction occurring at 1442 days. All extractions were successful, with no procedural or long‐term complications. Indications for abandonment included the need for CRT (n = 6), battery depletion (n = 2), increasing thresholds/failure to capture (n = 3), and pacemaker syndrome (n = 1). All procedures were successful, with no procedural or long‐term complications. Conclusion In this large single‐center study, 6% of patients implanted with a Micra required a system modification during long‐term follow‐up, most commonly due to the requirement for CRT pacing. These patients were managed successfully with extraction or abandonment.

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“…It was also shown that in patients receiving Micra following extraction due to a device infection, no recurring infections occured in longterm follow-up. [33][34][35]…”

Section: Discussionmentioning

confidence: 99%

Cardiac Implantable Electronic Device Infections: A Single Tertiary Care Center Experience

Bozyel¹

2020

South Clin Ist Euras

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The rate of cardiac implantable electronic device (CIED) infections has become prevalent in recent years, and they are related to severe complications, as well as a cost burden. In the present study, we assessed the results of our single tertiary care center experience. Methods: All patients who underwent CIEDs implantation between 2012 and 2018 with procedural and follow-up data available were included in this study. Results: Device infection was defined in six of 512 patients aged from 29 to 78 years old. The mean follow-up period was 2.8±1.7 years. They were new implants and system, removal which included a generator, and all transvenous leads were carried out for five cases. Removal of the generator and debridement of the pocket was performed in one case with isolated pocket erosion without local signs of infection and the wound was irrigated with antibiotic solution. A 2-week oral antibiotic therapy was administered to all patients following discharge. After reimplantation, there was no infection recurrence in three patients during 13±6.1 months follow-up period. Baseline characteristics, with the exception of implanted device types, were similar between infected and non-infected patients. Hematoma or pneumothorax was not observed in patients with device infection. Conclusion: Prevalent risk factors for device infections were not relevant to our patients. Our device infection rates (1.17%) were slightly lower, and there was no serious complication due to the device infection itself or its management.

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Micra pacemaker implant after cardiac implantable electronic device extraction: feasibility and long-term outcomes

Cited by 27 publications

References 16 publications

Leadless pacing in the elderly: never too old for something new

Leadless pacing in the elderly: never too old for something new

Life cycle management of Micra transcatheter pacing system: Data from a high‐volume center

Cardiac Implantable Electronic Device Infections: A Single Tertiary Care Center Experience

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