Micra™ Leadless Intracardiac Pacemaker Implantation: A Safer Option During the Coronavirus Disease 2019 Pandemic

Abstract

The Micra™ Transcatheter Pacing System (Medtronic, Minneapolis, MN, USA) is a fairly novel leadless intracardiac pacemaker implanted in the right ventricle via a femoral-vein transcatheter approach. Due to the less-invasive nature of the implantation procedure and its smaller size, patients receiving the Micra™ device tend to experience fewer complications, hospitalizations, and revisions when compared with those with transvenous pacemakers. Certain arrhythmias and conduction abnormalities, such as high-degree atrioventricular blocks, require urgent and timely pacemaker insertion-a necessity that has persisted even during the coronavirus disease 2019 (COVID-19) pandemic. Here, we present a case series of 10 patients with various conduction disease abnormalities who required right ventricle pacemaker implantation during the months of March to May 2020, which was the initial peak of the COVID-19 pandemic in New Jersey, including the enhanced precautions taken to avoid viral spread.

Implantation of cardiac electronic devices in active COVID-19 patients: Results from an international survey

“… 21 Another study on leadless pacemaker implantations reported 1 of 3 COVID-19 positive patient experienced in-hospital mortality on the third postoperative day secondary to hypoxic respiratory failure triggered by COVID-19. 16 The use of leadless pacemakers was suggested to reduce operator and staff exposure, and to reduce complications and hospitalization. 16 This approach was indeed seen in the US centers in our study, with a higher rate of leadless pacemakers implanted in the US, and in patients who were severely or critically ill and in those who expired.…”

“… 16 The use of leadless pacemakers was suggested to reduce operator and staff exposure, and to reduce complications and hospitalization. 16 This approach was indeed seen in the US centers in our study, with a higher rate of leadless pacemakers implanted in the US, and in patients who were severely or critically ill and in those who expired. In addition, a single chamber pacemaker or Micra VVI were implanted in 55 (33.1%) patients, of whom 35(63.6%) without a history of AF, and a significantly higher rate in patients who expired (56.3% vs 30.7%).…”

“… 5 , 6 , 7 , 8 , 9 , 10 There are only a few case reports and small case series in the literature of patients with COVID-19 who were implanted with a CIED while having active disease, and none reported procedural complications. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Active COVID-19 has implications for treating physicians and staff, and impacts CIED planning. The implanting physician and supporting staff need to wear personal protective equipment (PPE) during the procedure with possible impairment in their ability to perform the procedure.…”

The Utility of Leadless Atrioventricular Synchronous Pacemaker Implantation as a Novel Alternative to a Traditional Pacemaker During Pregnancy

“… 4 During the coronavirus disease 2019 (COVID-19) pandemic, leadless pacemakers were shown to be a safer alternative to traditional pacemakers in light of their less-invasive nature, which allows for a shorter procedure time and a reduced mean fluoroscopy time. 5 Here, we report an alternate novel approach to manage a pregnant patient with complete heart block by implanting a leadless pacemaker with minimal fluoroscopy exposure.…”