Acute and long‐term outcomes of simultaneous atrioventricular node ablation and leadless pacemaker implantation

Martínez‐Sande, José Luis; Rodríguez‐Mañero, Moisés; García‐Seara, Javier; Lago‐Lestón, Ramón Manuel; González‐Melchor, Laila; Kreidieh, Bahij; Iacopino, Saverio; Regibus, Valentina De; Greef, Yves De; Schwagten, Bruno; Curnis, Antonio; Sieira, Juan; Chierchia, Gian Battista; Brugada, Pedro; González-Juanatey, José Ramón; Asmundis, Carlo de

doi:10.1111/pace.13496

Cited by 8 publications

(11 citation statements)

References 18 publications

(40 reference statements)

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“…There are a few previously published reports regarding the safety and feasibility of this approach 9,10,16 . Similar to our international cohort, these small reports also suggest that this approach is safe and feasible.…”

Section: Discussionsupporting

confidence: 88%

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Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

El‐Chami

Shinn²,

Bansal

et al. 2021

Cardiovasc electrophysiol

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Background The feasibility and outcomes of concomitant atrioventricular node ablation (AVNA) and leadless pacemaker implant are not well studied. We report outcomes in patients undergoing Micra implant with concomitant AVNA. Methods Patients undergoing AVNA at the time of Micra implant from the Micra Transcatheter Pacing (IDE) Study, Continued Access (CA) study, and Post‐Approval Registry (PAR) were included in the analysis and compared to Micra patients without AVNA. Baseline characteristics, acute and follow‐up outcomes, and electrical performance were compared between patients with and without AVNA during the follow‐up period. Results A total of 192 patients (mean age 77.4 ± 8.9 years, 72% female) underwent AVNA at the time of Micra implant and were followed for 20.4 ± 15.6 months. AVNA patients were older, more frequently female, and tended to have more co‐morbid conditions compared with non‐AVNA patients (N = 2616). Implant was successful in 191 of 192 patients (99.5%). The mean pacing threshold at implant was 0.58 ± 0.35 V and remained stable during follow‐up. Major complications within 30 days occurred more frequently in AVNA patients than non‐AVNA patients (7.3% vs. 2.0%, p < .001). The risk of major complications through 36‐months was higher in AVNA patients (hazard ratio: 3.81, 95% confidence interval: 2.33–6.23, p < .001). Intermittent loss of capture occurred in three AVNA patients (1.6%), all were within 30 days of implant and required system revision. There were no device macrodislodgements or unexpected device malfunctions. Conclusion Concomitant AVN ablation and leadless pacemaker implant is feasible. Pacing thresholds are stable over time. However, patient comorbidities and the risk of major complications are higher in patients undergoing AVNA.

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Section: Discussionsupporting

confidence: 88%

“…For instance, Martinez‐Sande et. al 16 reported on 27 patients who received simultaneous LP and AVNA. Three patients experienced complications (11%) as compared with 5.5% complication rate in their cohort (127 patients) of patients that received LP without a concomitant AVNA.…”

Section: Discussionmentioning

confidence: 99%

Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

El‐Chami

Shinn²,

Bansal

et al. 2021

Cardiovasc electrophysiol

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“…Over the mean follow-up of 123 ± 48 days, 3.6% patients (n = 3) died, but all deaths were unrelated to cardiovascular causes. There were no significant differences between groups in terms of pacing and sensing threshold values [65].…”

Section: Av Nodal Ablation With Permanent Pacingmentioning

confidence: 70%

Leadless Pacemakers

Magnusson¹,

Pergolizzi²,

LeQuang³

2019

Cardiac Pacing and Monitoring - New Methods, Modern Devices

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Leadless or transcatheter pacemakers have recently been introduced to market with important benefits and some limitations. Implanted entirely within the right ventricle, these devices eliminate the need for transvenous pacing leads and pacemaker pockets and thus reduce the risk of infections and lead-related problems. Currently, they offer only VVI/R pacing and they cannot provide atrial sensing, antitachycardia pacing, or AV synchrony. They offer a number of features (such as rate response) and electrogram storage, albeit more limited than in a transvenous system. Real-world clinical data are needed to better comment on projected battery life, which manufacturers suggest will be at least equivalent to transvenous devices. Extracting an implanted leadless pacemaker remains a challenge, although proprietary snare and removal systems are available. However, a leadless pacemaker at end of service may be programmed to OOO and left in place; a revised device may be implanted adjacent. These innovative new devices may have important uses in special populations. Initial data on implant success and adverse events are favorable. Currently, there are two leadless pacemakers available: the Micra™ device by Medtronic and the Nanostim™ device by Abbott (formerly St. Jude Medical).

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“…The LPM design offers the possibility to perform the implantation and AVN ablation via a single venous femoral approach during the same procedure. A few case series showed the feasibility and safety of this approach 4–6 …”

Section: Introductionmentioning

confidence: 99%

Acute pacing threshold elevation during simultaneous Micra leadless pacemaker implantation and AV node ablation: Clinical cases, computer model and practical recommendations

Racine,

Dognin,

Zhao

et al. 2023

Pacing Clinical Electrophis

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BackgroundIn patients with refractory atrial fibrillation (AF), atrioventricular nodal (AVN) ablation and permanent pacemaker implantation is recommended. The Micra Transcatheter Pacing System (Micra) is a single chamber leadless pacemaker (LPM) and thus offers the possibility of AV node (AVN) ablation in the same procedure. Pacing threshold (PT) elevation after radiofrequency (RF) ablation is a potential complication.MethodsWe conducted a single center retrospective cohort study. Patients implanted with a Micra (n = 84) and concomitant or delayed AVN ablation (n = 12) from 2014 to 2022 were included. Two cases of acute Micra PT elevation immediately following RF AVN ablation required device retrieval and implantation of a new Micra. Procedural characteristics and electrophysiological parameters were analyzed, and a computer model was performed to determine factors responsible for acute PT elevations.ResultsA total of 84 patients were included. Mean age was 74 ± 10 and 48% were women. Twelve patients (14%) underwent AVN ablation. Two patients had acute PT elevation requiring device retrieval despite no direct contact of the ablation catheter with the Micra. Computer modeling shows that significant dissipated power due to electrical field coupling can occur at the tip or ring electrode if the catheter is not kept at a safe distance (≥35 mm) from the Micra when a maximum power of 100 W is delivered.ConclusionConcurrent AVN ablation and Micra implantation is safe in most patients. To prevent acute PT elevation, keeping a safe distance of ≥35 mm from the tip and ring electrodes of the Micra and using lower power output may prevent this complication.

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Acute and long‐term outcomes of simultaneous atrioventricular node ablation and leadless pacemaker implantation

Cited by 8 publications

References 18 publications

Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

Leadless pacemaker implant with concomitant atrioventricular node ablation: Experience with the Micra transcatheter pacemaker

Leadless Pacemakers

Acute pacing threshold elevation during simultaneous Micra leadless pacemaker implantation and AV node ablation: Clinical cases, computer model and practical recommendations

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