Leadless Medtronic Micra pacemaker almost completely endothelialized already after 4 months: first clinical experience from an explanted heart

Borgquist, Rasmus; Ljungström, Erik; Koul, Bansi; Höijer, Carl-Johan

doi:10.1093/eurheartj/ehw137

Cited by 29 publications

(21 citation statements)

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“…Pathologic examinations of leadless devices at autopsy or after explant have revealed a range of device endothelialization, from partial at 19 months to full at 4 months. 29,30 As of this writing, no extraction complications have been observed with Nanostim explants up to 506 days after implant (n = 12, mean 197 days after implant). 31 Needless to say, there is not yet enough experience worldwide with either system to know what the end-of-service will look like in 10 to 15 years.…”

Section: ■ Advantages Of Leadless Pacingmentioning

confidence: 76%

Leadless cardiac pacing: What primary care providers and non-EP cardiologists should know

Kiehl

Cantillon

2016

CCJM

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Over the last 50 years, the use of transvenous pacemakers has been constrained by long-term complications that affect more than 1 in 10 patients, largely attributable to the endovascular leads and surgical pocket. Leadless cardiac pacing involves a self-contained pacemaker deployed directly into the heart without a lead or incisional access. The procedure has shown promise, eliminating pocket-related complications. Other advantages include postprocedural shoulder mobility and the ability to drive, shower, and bathe. Current devices are limited to single-chamber ventricular pacing. Future advances may allow atrial and dual-chamber pacing and combination with a subcutaneous defibrillator to deliver antitachycardia pacing and provide bradycardia backup.

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Section: ■ Advantages Of Leadless Pacingmentioning

confidence: 76%

Leadless cardiac pacing: What primary care providers and non-EP cardiologists should know

Kiehl

Cantillon

2016

CCJM

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“…We felt this was a safe alternative to temp-perm placement in patients without active bacteremia given the small profile of the Micra™ system in the bloodstream, its small surface area, and the rapid endothelialization of this kind of device. 16 In fact, a large retrospective study of all registered Micra™ revisions suggested no device-related infections prompting extraction have occurred. 17 The strategy of implanting an LPS at the time of extraction was previously demonstrated to be safe in a small single-center case series and larger retrospective cohort analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Because of this, patients needing ICD therapy require an additional subcutaneous ICD implantation or implantation of another transvenous ICD system as previously described. 16 The Micra™ system also has a higher cost than a traditional transvenous lead system; however, it is possible that the significant reduction in the hospital LOS observed in the LPS cohort may still support Micra™ as a cost-effective approach as compared with the use of externalized PGs. Further research to address this question should be pursued.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Leadless Pacing and Temporary Externalized Pacing Following Cardiac Implanted Device Extraction

Gonzales¹,

Richardson²,

Montgomery³

et al. 2019

J Innov Cardiac Rhythm Manage.

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Pacemaker-dependent (PD) patients undergoing implantable cardiac electronic device extraction often must be subjected to temporary pacing interventions. We sought to determine the safety and utility of a leadless pacing system (Micra™; Medtronic, Minneapolis, MN, USA) in patients undergoing system extraction as compared with externalized temporary transvenous right ventricular lead (temp-perm) placement. We performed a retrospective cohort analysis of all patients receiving either permanent Micra™ or temp-perm systems following system extraction from

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“…16 Previous studies have shown that these devices have a range of endothelialisation, from partial at 19 months to full at 4 months, which can increase the risk of complications. 17,18 An imperative determinant of successful CRT for heart failure is the position of the LV pacing lead. 6,12 LV intracardiac structures limit the placement of currently manufactured designs to primarily apical regions.…”

Section: Discussionmentioning

confidence: 99%

Tracking the motion of intracardiac structures aids the development of future leadless pacing systems

Razeghi

Strocchi

Lee

et al. 2020

Cardiovasc electrophysiol

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Background Leadless pacemakers preclude the need for permanent leads to pace endocardium. However, it is yet to be determined whether a leadless pacemaker of a similar design to those manufactured for the right ventricle (RV) fits within the left ventricle (LV), without interfering with intracardiac structures. Methods Cardiac computed tomography scans were obtained from 30 patients indicated for cardiac resynchronisation therapy upgrade. The mitral valve annulus, chordae tendineae, papillary muscles and LV endocardial wall were marked in the end‐diastolic frame. Intracardiac structures motions were tracked through the cardiac cycle. Two pacemaker designs similar to commercially manufactured leadless systems (Abbott's Nanostim LCP and Medtronic's Micra TPS) as well as theoretical designs with calculated optimal dimensions were evaluated. Pacemakers were virtually placed across the LV endocardial surface and collisions between them and intracardiac structures were detected throughout the cycle. Results Probability maps of LV intracardiac structures collisions on a 16‐segment AHA model indicated possible placement for the Nanostim LCP, Micra TPS, and theoretical designs. Thresholding these maps at a 20% chance of collision revealed only about 36% of the endocardial surface remained collision‐free with the deployment of Micra TPS design. The same threshold left no collision‐free surface in the case of the Nanostim LCP. To reach at least half of the LV endocardium, the volume of Micra TPS, which is the smaller design, needed to be decreased by 41%. Conclusion Due to the presence of intracardiac structures, placement of leadless pacemakers with dimensions similar to commercially manufactured RV systems would be limited to apical regions.

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Leadless Medtronic Micra pacemaker almost completely endothelialized already after 4 months: first clinical experience from an explanted heart

Cited by 29 publications

References 0 publications

Leadless cardiac pacing: What primary care providers and non-EP cardiologists should know

Leadless cardiac pacing: What primary care providers and non-EP cardiologists should know

Comparison of Leadless Pacing and Temporary Externalized Pacing Following Cardiac Implanted Device Extraction

Tracking the motion of intracardiac structures aids the development of future leadless pacing systems

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