Unipolar atrial signal analysis combined with CF sensing ensures a robust 2-year SR maintenance rate in the treatment of PAF. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02520960.
A patient with Brugada syndrome experienced incessant ventricular fibrillation 7 years after implantation of an ICD. General anesthesia, fast ventricular pacing, bretylium, and atenolol infusion were ineffective; amiodarone infusion was started. After 190 defibrillation shocks over 36 hours, the electrical storm stopped. A multiorgan failure occurred as a complication of the electrical storm and necessitated prolonged reanimation. Thorough cardiac evaluation revealed no structural abnormality and the patient, now on chronic oral amiodarone therapy, remains free of arrhythmia 1 year after the event.
Extraction of three chronically implanted pacemaker leads was performed via the implant vein in a 71-year-old man. One of the leads broke in the subclavian scar tissue. The lead fragment migrated into the left peroneotibial trunk artery. Transesophageal echocardiography showed patent foramen ovale associated with right-to-left atrial shunt. This complication of lead extraction is discussed along with the role of echocardiography prior to lead removal.
Background
Transvenous pacemaker (PM) implantation is a complication in patients undergoing transcatheter aortic valve implantation (TAVI). Recently, a second generation of leadless PMs able of atrioventricular (AV) synchronous pacing has been introduced and could be an alternative when ventricular pacing is required after TAVI. Real‐world data on Micra AV after TAVI are still lacking. Our aim was to determine the per‐ and post‐procedural outcomes in patients with Micra AV leadless PM implantation after TAVI.
Methods
A total of 20 consecutive patients underwent Micra AV leadless PM implantation after TAVI between November 2020 and June 2021.
Results
The main indication for ventricular pacing was high‐degree AV block (55% of patients) and left bundle branch block (LBBB) associated with prolonged HV interval (45% of patients). At discharge, mean (SD) ventricular pacing threshold was 0.397 ± 0.11 V at 0.24 ms and ventricular impedance was 709.4 ± 139.1 Ω. At 1‐month follow‐up, 95% of patients were programmed in VDD pacing mode. Mean (SD) ventricular pacing threshold was 0.448 ± 0.094 V at 0.24 ms. In patients with ventricular> pacing > 90% (n = 5), mean AM‐VP was 72.5% ± 8.3%. Pacing threshold at 1 month was not significantly different compared to discharge (p = .1088). Mean (SD) impedance was 631.0 ± 111.9 Ω, which remained stable at discharge (p = .0813). No procedural complications occurred during implantation. At 1‐month follow‐up, two patients displayed atrial under‐sensing.
Conclusions
Micra AV leadless PM implantation after TAVI is associated with a low complication rate and good device performance at 1‐month post‐implantation.
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