An indissoluble knot: An unexpected troubleshooting during Micra implantation

Cipolletta, Laura; Volpato, Giovanni; Biffi, Mauro; Capucci, Alessandro

doi:10.1111/pace.13584

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…Moreover, clot formation inside the delivery system has recently been reported in association with a case of indissoluble knot formation. Adequate heparinized saline flow rate was recommended by the authors . In our case, high flow rate of heparinized saline did not prevent knot and clot formation.…”

Section: Discussionmentioning

confidence: 60%

Troubleshooting in PM Leadless: How to manage an indissoluble knot

Morani

Bolzan

Tomasi

et al. 2019

Journal of Arrhythmia

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A 77‐year‐old patient, with permanent atrial fibrillation, underwent successful Micra transcatheter pacing system (MTPS) implantation. Once begun the pull‐back of the tether, an increasing resistance was felt by the operator until complete blockage. A challenging recapture of MTPS into the delivery system was performed. The retrieved MTPS showed an indissoluble knot close to the docking button that blocked the running of the tether, and a long clot inside the delivery system. The new design of internal handle components of MTPS recently updated seems to favor clot formation. We suggest a reconsideration of the standard recommendations about delivery system flushing and design of the inner flushing tube system.

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Section: Discussionmentioning

confidence: 60%

Troubleshooting in PM Leadless: How to manage an indissoluble knot

Morani

Bolzan

Tomasi

et al. 2019

Journal of Arrhythmia

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“…Albeit its low incidence, LPM clot formation on the tip of the device or inside the delivery system has been described in the literature. 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.…”

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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“…Few reports have demonstrated the difficulties encountered during leadless pacemaker implantation when pulling the tether. 6 7 Cipolletta et al 6 reported a clot on a tether. 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.…”

Section: Discussionmentioning

confidence: 99%

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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An indissoluble knot: An unexpected troubleshooting during Micra implantation

Cited by 7 publications

References 3 publications

Troubleshooting in PM Leadless: How to manage an indissoluble knot

Troubleshooting in PM Leadless: How to manage an indissoluble knot

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

Difficulty removing a leadless pacemaker in a post-transfusion patient

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