Implantation of leadless pacing systems in patients early after tricuspid valve surgery: A feasible option

Abstract

Background After tricuspid valve (TV) surgery due to tricuspid regurgitation (TR), patients needing a permanent pacemaker often receive an epicardial lead implantation. This may result in delayed recovery from open‐chest surgery and increased postoperative risk. Leadless pacemaker (LPM) implantation may represent a valuable option. Methods and Results A total of 14 consecutive patients underwent LPM implantation (Micra Transcatheter Pacing System, Medtronic, Minneapolis, MN) early after TV surgery. The pacing indication in those patients was atrial fibrillation with a slow atrio‐ventricular (AV) conduction or atrial fibrillation and a concomitant AV block III. Three patients already had a pacemaker prior to surgery, which was explanted during TV repair. Three patients received a valve replacement with a bioprosthesis, while the remaining eight patients received a TV repair. All procedural data and device measurements during and after LPM implantation were recorded. Transthoracic echocardiography was performed prior and post LPM implantation, showing no changes in TV or bioprosthesis performance. The device measurements were within an adequate range: threshold: 0.83 ± 0.34 V @ 0.24 ± 0 ms, impedance: 480 ± 58.88 ohm, and R‐wave: 10.10 ± 3.60 mV. LPM implantation was successful in all patients with a mean procedural time of 32 ± 11.8 minutes, fluoroscopy time of 3.71 ± 3.15 minutes, and dose‐area product of 536.67 ± 811.26 cGy/m2. Conclusions Implantation of an LPM early after TV surgery is a feasible option. LPM implantation does not affect TV or bioprosthesis performance in transthoracic echocardiography.

Evolution of tricuspid valve regurgitation after implantation of a leadless pacemaker: A single center experience, systematic review, and meta‐analysis

“…Eighty‐two studies were further examined in full text, and seven met the pre‐specified inclusion criteria (Figure 2). 8,9,11,12,16–18 The included studies from 2016 to 2022 were mostly of retrospective nature and encompassed data from 297 patients: 255 patients with a Micra™ LLPM and 42 patients with a Nanostim™ LLPM, whereof 42% (Micra™) and 32% (Nanostim™) were women. Mean age was 79.8 ± 2.5 years for Micra™ and 81.0 ± 1.4 years for Nanostim™ patients.…”

“…Eighty-two studies were further examined in full text, and seven met the pre-specified inclusion criteria (Figure 2). 8,9,11,12,[16][17][18]…”

Management of a patient with multiple device replacements and extractions: When the leadless pacemaker is a viable solution

“…An intracardiac device such as leadless PM may theoretically avoid interaction with the tricuspid valve. Beurskens et al, [14][15][16] reported a study of the impact of LPs on cardiac and valvular structure and function, showing LP therapy was unexpectedly associated with an increase in TV dysfunction, comparable to changes seen in patients with DDD transvenous pacemaker systems.…”

First-in-human combined transcatheter tricuspid valve implantation with leadless VDD pacemaker via left internal jugular approach

“…Leadless pacemaker (LP) systems are entirely contained in the right ventricle, with no leads across the tricuspid valve, thereby avoiding these concerns. Reports describing LP implantation in patients after recent tricuspid valve repair or replacement 4,5 cite a similar justification for their use. While LP have been successfully implanted in young patients, from varying approaches, 6,7 and in unusual anatomic situations, 8 there are no reports of LP implantation through a percutaneously implanted tricuspid valve.…”