Leadless pacing in the elderly: never too old for something new

Abstract

Rates of cardiac pacemaker implantation rise with age, and, meanwhile, elderly patient may be at great risk of complications, as pneumothorax, lead perforation, or pocket dehiscence. The use of leadless pacemaker could overcome peri- and post-procedural complications related to the presence of transvenous leads and pocket. The study aims to investigate feasibility and outcomes of Micra Transcatheter Pacing System (M-TPS) implantation in elderly, which represents a challenge for conventional cardiac pacing. Between May 2014 and July 2019, 109 patients (88 males, mean age 77.71±9.68 years) underwent M-TPS implantation at our Center, targeting a non-apical site of delivery when feasible. Study population was divided into two groups according to age (group 1 <79 years vs group 2 group 2 ≥80 years). The outcome evaluation included electrical performance at hospital discharge, and during follow-up. In 46/109 cases (34 males, 73.91%) M-TPS was implanted in patients older than 80 years. There were no statistically significant differences between groups for demographics characteristics, except for age. The procedure was performed via the right femoral access in 102/109 cases and was successful in all cases, with no device-related events. No differences were observed between groups in procedure duration, single device delivery, electrical performance at implant and at 12 month F-U. MTP-S implant is an effective and safe procedure in elderly patients, with similar electrical performance and outcome compared with younger patients at mid-term follow-up.

Efficacy and Safety of Leadless Pacemaker Implantation in Octogenarians

“…The success rate of Micra TPS implantation in the total population was 98.6% which is in line with data from the IDE (99.2%) as well as the post-market registry (PAR) (99.1%) [8]. Furthermore, it is comparable to observational data from other registries focusing on the elderly population which also reported successful implantation rates of >98% [10][11][12][13]. However, previous studies on Micra TPS in octogenarians have either included a lower number of patients or focused on the comparison of leadless versus conventional transvenous pacemaker implantation in octogenarians, while our study included a higher number of patients in the octogenarian group and focused on the comparison of clinical outcome of Micra TPS implantation in non-octogenarians versus octogenarians.…”

“…In addition to advanced age being a risk factor for cardiac complications during implantation, there have been concerns about the use of the Micra TPS device in frail elderly patients due to the size of the insertion tool. However, previous reports have demonstrated that implantation of a leadless pacemaker in advanced age is safe and effective [10][11][12][13]. Since the number of elderly patients in need for a pacemaker increases, it is of paramount importance to gain more information on the efficacy and especially safety of Micra TPS implantation in this population.…”

Percutaneous extraction of a Micra AV transcatheter pacing system due to a rare sudden battery failure after 19 months from implantation: A first experience worldwide

“…4 Safety and efficacy of LPs was pointed out by several studies, even in older patients. 5,6 Indeed, in this case was considered the best option among pacing systems, due to old age and comorbidity of the patient, conditions that increase the risk of severe device-related complications. Furthermore, a duration of the battery was expected to be beyond the life-expectancy of the patient, due to the intermittent nature of AVB.…”

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

“…[1][2][3] They may offer new opportunities for patients with previous infections, device extraction and more generally, for fragile and older patients. [4][5][6] This case report describes a management strategy of a patient with a history of multiple previous device replacements, extractions, and malfunction of conventional transvenous systems, who underwent a successful LP implantation.…”

“…Leadless pacemakers (LPs) have shown a high profile of safety and efficacy 1–3 . They may offer new opportunities for patients with previous infections, device extraction and more generally, for fragile and older patients 4–6 …”