Micra pacemaker in adult congenital heart disease patients: A case series

Abstract

Introduction: Implantation of transvenous endocardial or epicardial pacemakers presents specific challenges in adult congenital heart disease (ACHD) patients. Micra leadless permanent pacemakers (Micra PPM) may overcome some of these difficulties.Methods: Fifteen ACHD patients who underwent Micra PPM insertion were retrospectively evaluated.Results: Males 53.3%. Mean age at study: 37.5 ± 10.7 years. Mean age at Micra PPM insertion: 35.5 ± 11.0 years. Mean follow-up so far: 2.0 ± 0.3 years. Concerning the ACHD patients, 6.7% had a simple defect, 66.6% had a moderately complex defect, 26.7% were complex. Four patients (26.7%) had a previous PPM implantation. Three patients (20%) had a systemic right ventricle. Two patients (13.3%) had a single ventricle physiology. Five (33.3%) had Trisomy 21. The most commonly used Micra PPM modality was single chamber ventricular pacemaker (73.3%). Mean threshold post implantation was 0.48 V [range: 0.25−1.13 V], while mean threshold at 6 months control was 0.60 V [range: 0.38−1.13 V] (p = ns). Mean R wave postimplantation was 10.3 V [range: 3.25−19.4 V], whilst mean R wave at 6 months follow-up was 10.1 V [range: 3.5−19.0 V] (p = ns). No major peri and postprocedural complications were encountered.Conclusions: since ACHD patients are living longer and surviving into adulthood, the incidence of conduction disorders continues to increase, as part of the natural history of some lesions or as early or late complication of surgery. The Micra leadless PPM can be successfully implanted in ACHD patients and have significant theoretical advantages. They should be considered when transvenous and epicardial pacing are either contraindicated or represent an otherwise suboptimal approach.

Medical Therapy for Heart Failure in Adult Congenital Heart Disease Patients

“… 79 Leadless pacemakers have also been used across a spectrum of nonrepaired and repaired ACHD, including those with systemic RVs and single ventricle physiology, with no major peri- and post-procedural complications encountered. 80 …”

Different leadless pacemakers working in harmony (Aveir in the atrium/Micra AV2 in the ventricle) in a patient with dextrocardia and double outlet right ventricle after high‐risk infected device extraction

“…Atrial and ventricular pacing may be present due to atriotomy scars or atrial arrhythmia ablations with subsequent sinus node dysfunction or may have a ventricular septal defect or altered His‐Purkinje anatomy due to their underlying defect 1,2 . The Micra (Medtronic) leadless pacemaker use has been described in adult congenital patients with repaired or unrepaired congenital heart disease 3–5 . We present the first description of two separate types of leadless pacing devices used in the same patient with complex congenital anatomy with moderate tricuspid regurgitation and requiring atrial and ventricular pacing who was a complex prohibitive risk for a standard permanent pacemaker.…”

“…1,2 The Micra (Medtronic) leadless pacemaker use has been described in adult congenital patients with repaired or unrepaired congenital heart disease. [3][4][5] We present the first description of two separate types of leadless pacing devices used in the same patient with complex congenital anatomy with moderate tricuspid regurgitation and requiring atrial and ventricular pacing who was a complex prohibitive risk for a standard permanent pacemaker.…”