Troubleshooting in PM Leadless: How to manage an indissoluble knot

Morani, Giovanni; Bolzan, Bruna; Tomasi, Luca; Zimelli, Emma; Marini, Paola; Ribichini, Flavio

doi:10.1002/joa3.12211

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…They implanted a leadless pacemaker in a 77-year-old man and experienced difficulty releasing the device and retracting the delivery due to a clot on the tether. Morani et al 7 reported a similar case; they discussed delivery system flushing and the design of the inner flushing tube system. Both reports did not mention coagulability.…”

Section: Discussionmentioning

confidence: 95%

Difficulty removing a leadless pacemaker in a post-transfusion patient

et al. 2021

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A 99-year-old woman with atrial fibrillation bradycardia and symptomatic long pauses underwent a leadless pacemaker implantation after red blood cell transfusion due to anaemia. The patient’s blood tests after transfusion showed hypercoagulability; haematocrit, haemoglobin and fibrinogen levels were increased from 24.5% to 33.2%, 76 g/L to 111g/L, and 346 mg/dL to 646 mg/dL, respectively. Blood tests showed no hereditary hypercoagulability disorder and she had no history of thrombophilia. A leadless pacemaker was implanted in the correct position in the right ventricle. Heparin was administered after sheath insertion and the leadless pacemaker system was thoroughly flushed with heparinised saline before the tether was cut; however, removing the tether after leadless pacemaker implantation was difficult because clots had formed on the tether.

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Section: Discussionmentioning

confidence: 95%

Difficulty removing a leadless pacemaker in a post-transfusion patient

et al. 2021

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“… 21 , 22 Device release and delivery system retraction can be interrupted if a clot forms on the tether. This can either be operator-related where following the design of the inner flushing tube system of the LPM implantation device, a certain operator technique can reduce the clotting risk, 23 or case-by-case–related factors where preprocedural blood transfusion may increase blood viscosity, hence increasing clot formation. 24 On the other hand, our study shows that TV-VVI patients were more likely to undergo CIED revisions during the same admission in comparison to LPM.…”

Section: Discussionmentioning

confidence: 99%

Comparison of in-hospital outcomes and complications of leadless pacemaker and traditional transvenous pacemaker implantation

Alhuarrat,

Kharawala,

Renjithlal

et al. 2023

Europace

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Introduction Since their introduction in 1958, traditional cardiac pacemakers have undergone considerable upgrades over the years, but they continue to have a complication rate of around 3.8% to 12.4%. There are no randomized controlled trials comparing outcomes of leadless pacemakers (LPM) with single chamber transvenous pacemakers (TV-VVI). Objective Assess the differences in the procedural complications and in-hospital outcomes between LPM and TV-VVI implants. Methods We queried the national inpatient database from 2016–2019 to include adult patients undergoing LPM and TV-VVI. Admissions for leadless and single lead transvenous pacemakers were identified by their appropriate ICD-10 codes. Complications were identified using ICD-10 codes that mostly represent initial encounter. The difference in outcomes was assessed using Multivariable logistic regression and 1:1 propensity score matching between the two cohorts. Results 35,430 expanded sample of admissions was retrieved of which 27,650(78%) underwent TV-VVI with a mean age 81.3±9.4 years and 7,780(22%) underwent LPM with a mean age of 77.1±12.1 years. LPM group had a higher likelihood of in-hospital mortality (aOR:1.63, 95%CI[1.29–2.05], p <0.001), vascular complications (aOR:7.54, 95%CI[3.21–17.68], p<0.001), venous thromboembolism (aOR:3.67, 95%CI [2.68–5.02], p<0.001), cardiac complications (aOR:1.79, 95%CI[1.59–2.03], p<0.001), device thrombus formation (aOR:5.03, 95% CI[2.55–9.92], p<0.001) and need for a blood transfusion (aOR:1.54, 95%CI[1.14–2.07], p<0.005, respectively). TV-VVI group had higher likelihood of in-hospital pulmonary complications (aOR:0.68, 95%CI[0.54–0.87], p<0.002) and need for device revisions (aOR:0.42, 95%CI[0.23–0.76], p<0.004). Conclusion There is a higher likelihood of all-cause in-hospital mortality and complications following LPM implantation in comparison to TV-VVI. This could be related to higher co-morbidities in the LPM group. Clinical trials aimed to accurately compare between these two groups should be undertaken.

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“…Both approaches require femoral venous access with insertion of a TPS introducer sheath, but then diverge with regard to the specific tool employed to engage the TPS during the next step: the snare is advanced through either i) the integrated protectable sleeve of the TPS delivery catheter (as employed in our case series), or ii) a steerable sheath [10]. In using a steerable sheath, a short sheath (11)(12)(13)(14)(15)(16) is first inserted into the introducer sheath to prevent back bleeding, and a steerable sheath (for example, 8.5 Fr, Agilis NXT, Abbott Laboratories, Abbott Park, IL, USA) is inserted and advanced into the RV.…”

Section: Figure 3: Intracardiac Echocardiography (Ice)mentioning

confidence: 99%

Late Retrieval of the Leadless Micra Transcatheter Pacemaker System

Minami¹

2021

JCCI

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Aim: We report our single-center experience with the retrieval and replacement of the chronically implanted Micra transcatheter pacing system (TPS). Material and Methods: We included 6 patients with an implanted the Micra TPSs who subsequently underwent transvenous method of retrieval at our institution. The indication for device retrieval was pacemaker syndrome in two patients, battery depletion in three patients, and need for upgrade to biventricular pacing in one patient. Results: After an implantation duration of 555 ± 373 days, the overall retrieval success rate was 83.3%, 5 of 6 patients. No procedure-related adverse device events occurred. In the single patient with unsuccessful retrieval, intracardiac echocardiography revealed that the Micra TPS was embedded within the cardiac wall and surrounding tissue. After retrieval, four patients received a new Micra TPS. Conclusions: Late retrieval of an implanted Micra TPS was safe and feasible, which indicates the possibility for their safe and elective replacement with a new leadless pacing device.

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Troubleshooting in PM Leadless: How to manage an indissoluble knot

Cited by 4 publications

References 5 publications

Difficulty removing a leadless pacemaker in a post-transfusion patient

Difficulty removing a leadless pacemaker in a post-transfusion patient

Comparison of in-hospital outcomes and complications of leadless pacemaker and traditional transvenous pacemaker implantation

Late Retrieval of the Leadless Micra Transcatheter Pacemaker System

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