State of the art: leadless ventricular pacing

Abstract

Background Cardiac pacing has been shown to improve quality of life and prognosis of patients with bradycardia for almost 60 years. The latest innovation in pacemaker therapy was miniaturization of generators to allow leadless pacing directly in the right ventricle. There is a long history and extensive experience of leadless ventricular pacing in Austria. However, no recommendations of national or international societies for indications and implantation of leadless opposed to transvenous pacing systems have been published so far. Results A national expert panel of skilled implanters gives an overview on the two utilized leadless cardiac pacing systems and highlights clinical advantages as well as current knowledge of performance and complication rates of leadless pacing. Furthermore, a national consensus for Austria is presented, based on recent studies and current know-how, specifically including indications for leadless pacing, management of infection, suggestions for qualification, and training of the operators and technical standards. Conclusions Leadless pacing systems can be implanted successfully with a low complication rate, if suggestions for indications and technical requirements are followed. Condensed abstract An overview of the two utilized leadless cardiac pacing systems is given, specifically highlighting clinical advantages as well as current knowledge of performance and complication rates. Furthermore, a national consensus for Austria is presented, specifically including indications for leadless pacing, management of infection, and suggestions for qualification and technical standards.

Lost but Not Lost—Embolization of a Leadless Pacemaker to the Pulmonary Artery with Consecutive Endovascular Recovery

“…Although the proportion of right ventricular pacing was less than 1%, the patient showed good clinical response to pacemaker therapy as there was no recurrence of syncope since beginning of treatment. Possible treatment strategies (generator change vs. TPS implantation) were discussed with the patient, and we decided to opt for a TPS according to current recommendations [ 7 ].…”

<p>Cardiac Electronic Devices: Future Directions and Challenges</p>

“…Importantly, the potential benefits of LCPs must be confronted with the limited data on the long-term follow-up, and also the procedure of device replacement or retrieval is still debated. 34 According to a national expert consensus document of the Austrian Society of Cardiology, LCP retrieval should not be recommended as a routine procedure and should be limited only to specific issues, ie, endocarditis or system upgrades. 34 One worldwide experience of 40 successful device retrievals revealed that it may be feasible and safe if performed with a special sheath and a snare catheter and introduced via femoral access.…”

“…34 According to a national expert consensus document of the Austrian Society of Cardiology, LCP retrieval should not be recommended as a routine procedure and should be limited only to specific issues, ie, endocarditis or system upgrades. 34 One worldwide experience of 40 successful device retrievals revealed that it may be feasible and safe if performed with a special sheath and a snare catheter and introduced via femoral access. The most common reasons for extraction included elevated pacing threshold, endovascular infection, and indications for a system upgrade to a transvenous device.…”

“…35 If it is necessary to replace the battery, a new LCP may be implanted next to old devices without extraction of previous ones; however, current clinical experience is very limited. 34 The results of the Micra Transcatheter Pacing Study 36 showed the safety and efficacy(primary safety and efficacy end points were reached in 96% and 98.3%, respectively) of LCPs among 725 patients who had undergone device implantation. Likewise, the Micra Post-Approval Registry 37 reported a high rate of successful LCP implantations (99.1%) with a low risk of major complications (2.7%) among 1,817 patients.…”

2020 MR Safety for Cardiac Devices: An Update for Radiologists

“…It is a small capsule with a single chamber (VVI) PM system implanted in the right ventricle, usually via a transfemoral catheter (Figure 6). Leadless PMs have a lower rate of displacement, less torque, and less heating than conventional PMs due to their small size and the absence of a lead 45,46 (Figure 7). The Micra System and all leadless PMs are MR conditional at 1.5 and 3 T. 47,48…”