Anesthetic consideration for patients with micra leadless pacemaker

Abstract

MICRA, miniaturized leadless single chamber pacemaker, is inserted directly into the right ventricular myocardium via transcatheter approach. We present a case of a 66-year-old patient with a Micra pacemaker scheduled for kidney-pancreas transplant. The patient is pacemaker dependent. The preoperative cardiology consult did not comment on the need of reprogramming. One hour prior to the surgery, the anesthesia team was unable to locate the pacemaker on the chest wall. The Medtronic hotline was called, and the caregivers learned that the particular pacemaker is buried within the ventricular wall and is not responsive to an external magnet. Thus, the case was delayed and a cardiac electrophysiology team was contacted to reprogram the pacemaker to VOO (fixed ventricular pacing) mode. We suggest that the pacemaker can pose perioperative challenges due to its novelty, paucity of report, and guidelines.

Perioperative Considerations for Modern Leadless Pacemakers

“…The surgeon should be encouraged to utilize bipolar cautery, and for unipolar cautery, the electrosurgery dispersive electrode should be positioned to direct the current path at least 15 centimeters away from the device. 56 A transcutaneous pacing system should be available in the operating room for instances of sustained, inappropriate pacing inhibition.…”

“…Situations that merit immediate postoperative interrogation include the use of monopolar cautery, emergency surgery, cardioversion, or situations where a patient requires heart rate modulation for hemodynamic instability. 56 Advanced Cardiac Life Support. Similar to the approach to advanced cardiac life support (ACLS) for patients with a traditional transvenous pacemaker, there are no specific modifications to ACLS for patients with leadless pacemakers.…”

“…Situations that merit immediate postoperative interrogation include the use of monopolar cautery, emergency surgery, cardioversion, or situations where a patient requires heart rate modulation for hemodynamic instability. 56…”

Wireless Interrogation During Cardiac Surgery For a Patient With Aveir Leadless Pacemaker: A Case Report

“…However, some patients require cardiac surgery within this timeframe. Although recent reports describe safe anesthetic management for patients with LPs, [7][8][9] there are no reports on cardiac surgery in the early phase after LP implantation. Intraoperative device dislodgement may worsen the hemodynamic status because of pulmonary embolism or arrhythmias.…”