Outcomes of Micra Leadless Pacemaker Implantation With Uninterrupted Anticoagulation

Kiani, Soroosh; Black, George B.; Rao, Birju; Thakkar, Nancy; Massad, Christopher; Akshar, Patel; Merchant, Faisal M.; Hoskins, Michael; Delurgio, David B.; Patel, Ankit; León, Angel R.; Westerman, Stacy; Lloyd, Michael S.; Chami, Mikhael El

doi:10.1016/s0735-1097(19)31028-9

Cited by 3 publications

(4 citation statements)

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“…San Antonio et al, 17 in a series of 107 patients, found no difference in complication rates after implantation regardless of the periprocedural anticoagulation strategy (continuation in all VKA‐treated patients vs. 12–24 h interruption in LMWH or DOAC recipients). In another study, Kiani et al 18 found similar outcomes in patients implanted on (VKA or DOAC) and off OAC, although their off‐OAC arm included patients without an indication for anticoagulation. Despite including more patients than both of these studies combined, our study still fails to provide a definitive answer for this issue, due to the low number of events and also to the multiplicity of periprocedural antithrombotic approaches in the case of anticoagulated non‐MHV patients.…”

Section: Discussionmentioning

confidence: 94%

Section: Procedural Outcomes Antithrombotic Strategies and Noninfecti...mentioning

confidence: 94%

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Outcomes of leadless pacemaker implantation in patients with mechanical heart valves

Loughlin

Pachón

Martínez‐Sande

et al. 2022

Cardiovasc electrophysiol

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Introduction: Device infections constitute a major complication of transvenous pacemakers. Mechanical heart valves (MHV) increase the risk of infective endocarditis (IE) and pacemaker infection, requiring lifelong vitamin K-antagonists (VKA), which may affect patient management. Leadless pacemakers (LP) are associated with low infection rates, posing an attractive option in MHV patients requiring permanent pacing. This study describes outcomes following LP implantation in patients with MHV. Methods: This is a multicenter, observational, retrospective study including consecutive patients implanted with an LP at 5 centers between June 2015 and January 2020. Procedural outcomes, antithrombotic management, complications, performance during follow-up and episodes of bacteremia and IE were compared between patients with and without an MHV (MHV and non-MHV groups).Results: Four hundred fifty-nine patients were included (74 in the MHV group, 16.1%, and 385 in the non-MHV group, 83.9%). Procedural outcomes and acute electrical performance were comparable between groups. Vascular complications and cardiac perforation occurred in 2.7 versus 2.3% (p = 1) and 0% versus 0.8% (p = 1) in the MHV group and non-MHV group. One case of IE occurred in the MHV group and 2 in the non-MHV group. In MHV patients, uninterrupted VKA was used in 83.8%, whereas 16.2% were heparin-bridged. Vascular complication or tamponade occurred in 1 (8.3%) MHV heparin-bridged patient versus 1 (1.6%) MHV uninterrupted VKA patient (p = .3). Conclusion:LP implantation outcomes in MHV patients are comparable to the general LP population. Device-related infections are rare following LP implantation, including in patients with MHV. In the MHV group, periprocedural anticoagulation management was not associated with significantly different rates of tamponade or vascular complication.

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Section: Discussionmentioning

confidence: 94%

Section: Procedural Outcomes Antithrombotic Strategies and Noninfecti...mentioning

confidence: 94%

Outcomes of leadless pacemaker implantation in patients with mechanical heart valves

Loughlin

Pachón

Martínez‐Sande

et al. 2022

Cardiovasc electrophysiol

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“…After electrical performance testing and confirmation of stability with a tug test, the device is released from the delivery system. Antibiotic prophylaxis and peri-procedural haemostasis are left at operator decision and centre-specific guide-lines; evidence suggests that uninterrupted therapeutic anticoagulation represents a safe option associated with shorter in-hospital length of stay [9]. Flushing the introducer with heparinized saline solution, however, is recommended in all patients [10,11].…”

Section: Implantation Techniquementioning

confidence: 99%

Leadless pacemaker technology: clinical evidence of new paradigm of pacing

Bencardino¹,

Scacciavillani²,

Narducci³

2022

Rev. Cardiovasc. Med.

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Despite continuous technological developments, transvenous pacemakers (PM) are still associated with significant immediate and longterm complications, mostly lead or pocket-related. Recent technological advances brought to the introduction in clinical practice of leadless PM for selected cohort of patients. These miniaturize devices are implanted through the femoral vein and advanced to the right ventricle, without leaving leads in place. Lack of upper extremity vascular access and/or high infective risk in patients requiring VVI pacing are the most common indications to leadless PM. The recently introduced MICRA AV leadless PM also allows ventricular synchronization through mechanical sensing of atrial contraction waves, thus solving the problem of AV synchronization. This review will discuss and summarize available clinical evidence on leadless PM, their performance compared to transvenous devices, current applications and future perspectives.

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“…The rate of the composite endpoint of all major access-related complications including groin access siterelated complications, effusion/tamponade, or procedure-related death was similar between both patients on anticoagulation and those off anticoagulation (3.8% vs 1.4%; P = 0.392). Major complications included a pseudoaneurysm in a patient that was on anticoagulation which was managed conservatively and an acute right lower extremity DVT in a patient that was off oral anticoagulation (22).…”

Section: Anticoagulation Management During Micra Implantmentioning

confidence: 99%

Anticoagulation Therapy in Patients Undergoing Micra Leadless Pacemaker Implantation

Kadado

Chalhoub

2022

Preprint

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Over the past decade, there has been significant improvement in the treatment of diseases of the conduction system and symptomatic bradyarrhythmias with the development of leadless pacemaker systems. The Micra transcatheter pacemaker system has been shown to mitigate a lot of the complications associated with traditional pacing systems, which are notably skin pocket and lead-related complications. Numerous studies have shown the low complication rates associated with Micra procedure; however, there have been no specific guidelines or recommendations surrounding periprocedural anticoagulant therapy. This is important because a significant percentage of patients requiring pacemaker therapy have an indication for anticoagulation therapy as well. Multiple studies have shown the safety of uninterrupted anticoagulation during Micra implant, however, there is insufficient high-quality data to recommend periprocedural systemic use of anticoagulation. In this paper, we review the available data surrounding anticoagulation therapy in patients undergoing Micra implantation and the potential bleeding risks associated with this procedure.

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Outcomes of Micra Leadless Pacemaker Implantation With Uninterrupted Anticoagulation

Cited by 3 publications

References 0 publications

Outcomes of leadless pacemaker implantation in patients with mechanical heart valves

Outcomes of leadless pacemaker implantation in patients with mechanical heart valves

Leadless pacemaker technology: clinical evidence of new paradigm of pacing

Anticoagulation Therapy in Patients Undergoing Micra Leadless Pacemaker Implantation

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