Concomitant leadless pacing in pacemaker-dependent patients undergoing transvenous lead extraction for active infection: Mid-term follow-up

Beccarino, Nicholas; Choi, Evan; Liu, Brian; Kim, Beom Soo; Pagan, Eric; Saleh, Moussa; Gabriels, James; Epstein, Laurence M.

doi:10.1016/j.hrthm.2023.02.003

Cited by 11 publications

(4 citation statements)

References 33 publications

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“…In the LEADLESS II study evaluating the Aveir LCP leadless pacemaker (Abbott), among 210 patients included, at 1‐year follow‐up, 2 patients developed PICM 18 . And in a study by Beccarino and colleagues among 86 patients who had LPs implanted during transvenous lead extraction, 6 (6.9%) developed PICM and required CRT upgrade 19 . Finally, in the Micra CED 3‐year follow‐up study, 1.5% of patients with Micra VR implant required CRT upgrade 12 .…”

Section: Discussionmentioning

confidence: 99%

“…18 And in a study by Beccarino and colleagues among 86 patients who had LPs implanted during transvenous lead extraction, 6 (6.9%) developed PICM and required CRT upgrade. 19 Finally, in the Micra CED 3-year follow-up study, 1.5% of patients with Micra VR implant required CRT upgrade. 12 Differences in the reported incidence of PICM between prior studies and our cohort may reflect the fact that our cohort included patients who had undergone prior cardiac surgery or structural valve interventions, which may augment the potential detrimental effects of interventricular dyssynchrony.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of leadless pacemaker implantation after cardiac surgery and transcatheter structural valve interventions

Huang,

Bhatia,

Lloyd

et al. 2023

Cardiovasc electrophysiol

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IntroductionPermanent pacing indications are common after cardiac surgery and transcatheter structural valve interventions. Leadless pacemakers (LPs) have emerged as a useful alternative to transvenous pacemakers. However, current commercially available LPs are unable to provide atrial pacing or cardiac resynchronization and relatively little is known about LP outcomes after cardiac surgery and transcatheter valve interventions.MethodsThis retrospective study included patients who received a Micra VR (MicraTM MC1VR01) or Micra AV (MicraTM MC1AVR1) (Medtronic) leadless pacemaker following cardiac surgery or transcatheter structural valve intervention between September 2014 and September 2022. Device performance and clinical outcomes, including ventricular pacing burden, ejection fraction, and need for conversion to transvenous pacing systems, were evaluated during follow‐up.ResultsA total of 78 patients were included, of whom 40 received a Micra VR LP implant, and 38 received a Micra AV LP implant. The mean age of the cohort was 65.9 ± 17.9 years, and 48.1% were females. The follow‐up duration for the entire cohort was 1.3 ± 1.1 years: 1.6 ± 1.3 years for the Micra VR group and 0.8 ± 0.5 years for the Micra AV group. Among the cohort, 50 patients had undergone cardiac surgery and 28 underwent transcatheter structural valve interventions. Device electrical performance was excellent during follow‐up, with a small but clinically insignificant increase in ventricular pacing threshold and a slight decrease in pacing impedance. The mean right ventricle pacing (RVP) burden significantly decreased over time in the entire cohort (74.3% ± 37.2% postprocedure vs. 47.7% ± 40.6% at last follow‐up, p < .001), and left ventricle ejection fraction (LVEF) showed a modest but significant downward trend during follow‐up (55.0% ± 10.6% vs. 51.5% ± 11.2% p < .001). Patients with Micra VR implants had significantly reduced LVEF during follow‐up (54.1% ± 11.9% vs. 48.8% ± 11.9%, p = .003), whereas LVEF appeared stable in the Micra AV group during follow‐up (56.1% ± 9.0% vs. 54.6% ± 9.7%, p = .06). Six patients (7.7%) required conversion to transvenous pacing systems, four who required cardiac resynchronization for drop in LVEF with high RVP burden and two who required dual‐chamber pacemakers for symptomatic sinus node dysfunction.ConclusionLeadless pacemakers provide a useful alternative to transvenous pacemakers in appropriately selected patients after cardiac surgery and transcatheter structural valve interventions. Device performance is excellent over medium‐term follow‐up. However, a significant minority of patients require conversion to transvenous pacing systems for cardiac resynchronization or atrial pacing support, demonstrating the need for close electrophysiologic follow‐up in this cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes of leadless pacemaker implantation after cardiac surgery and transcatheter structural valve interventions

Huang,

Bhatia,

Lloyd

et al. 2023

Cardiovasc electrophysiol

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“…The LPM is an evolving technology with apparently reduced risks of related infections, likely by obviating the need for the device pocket/incision as a potential factor in the infection process. Therefore, the leadless PM has been adopted in recent studies following TLE of infected CIED, or even during the same extraction procedure, with promising results regarding infection relapses [32,33]. However, concomitant LPM implantation during CIED extraction for active IE cannot be recommended based on these data since the LPM itself is not completely immune to infections, and a few cases of related IE with device vegetation have been reported [34].…”

Section: Leadless Pacingmentioning

confidence: 99%

Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis

Ali,

Foresti,

De Ambroggi

et al. 2023

JCM

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Despite progress in implantation technology and prophylactic measures, infection complications related to cardiac implantable electronic devices (CIED) are still a major concern with negative impacts on patient outcomes and the health system’s resources. Infective endocarditis (IE) represents one of the most threatening CIED-related infections associated with high mortality rates and requires prompt diagnosis and management. Transvenous lead extraction (TLE), combined with prolonged antibiotic therapy, has been validated as an effective approach to treat patients with CIED-related IE. Though early complete removal is undoubtedly recommended for CIED-related IE or systemic infection, device reimplantation still represents a clinical challenge in these patients at high risk of reinfection, with many gaps in the current knowledge and international guidelines. Based on the available literature data and authors’ experience, this review aims to address the practical and clinical considerations regarding CIED reimplantation following lead extraction for related IE, focusing on the reassessment of CIED indication, procedure timing, and the reimplanted CIED type and site. A tailored, multidisciplinary approach involving clinical cardiologists, electrophysiologists, cardiac imaging experts, cardiac surgeons, and infectious disease specialists is crucial to optimize these patients’ management and clinical outcomes.

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“…The effectiveness and safety of such a procedure in the mid-term were confirmed by Beccarino et al . [ 62 ] During a median follow-up of 163 days, no recurrence of infectious complications was found in any of the patients.…”

Section: Re-implantation After Cied Removal Due To Infectionmentioning

confidence: 99%

Prevention of Cardiac Implantable Electronic Device Infections: A Review

Sławiński¹,

Kempa²,

Przybylski³

2023

Rev. Cardiovasc. Med.

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The importance of cardiac implantable electronic devices (CIEDs) in the treatment of cardiac rhythm disturbances, heart failure, and the prevention of sudden cardiac death is indisputable. However, CIED therapy is associated with complications, among which infections are particularly unfavourable in terms of prognosis. The diagnosis and management of CIED infections remain complex, with a significant impact on mortality and healthcare costs. For these reasons, the risk factors for CIED infections and methods of their prevention have been assessed in recent years. This review summarises the current state of knowledge on the subject. We also outlined the role of alternative methods, such as subcutaneous defibrillators, leadless pacemakers, and wearable cardioverter defibrillators.

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Concomitant leadless pacing in pacemaker-dependent patients undergoing transvenous lead extraction for active infection: Mid-term follow-up

Cited by 11 publications

References 33 publications

Outcomes of leadless pacemaker implantation after cardiac surgery and transcatheter structural valve interventions

Outcomes of leadless pacemaker implantation after cardiac surgery and transcatheter structural valve interventions

Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis

Prevention of Cardiac Implantable Electronic Device Infections: A Review

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