Septal implantation of the Micra transcatheter pacing system guided by intraprocedural transesophageal echocardiography

Exploratory use of intraprocedural transesophageal echocardiography to guide implantation of the leadless pacemaker

“…Previous experience with conventional pacemakers suggests that fluoroscopy might be insufficient for guiding precise lead implantation in the IVS; therefore, use of intraprocedural TEE seems to be advisable. 3 , 18 Contrary to the study by Kaczmarek et al, 16 who suggested that an upper to midesophageal position of the TEE probe was the best location to visualize and facilitate septal positioning of the LP during implantation, our study favored the TEE transgastric (0°–40°/90°–130°) biplane view because it was reproducible in all study participants.…”

“…Although the midesophageal 60°–90° short-axis view allowed visualization of the LP, TV, and PV in the same 2-dimensional imaging plane, the IVS was not visible in this view. 16 Although The midesophageal 0°–30° 4-chamber view provided good visualization of the IVS, the LP and the pulmonic valve were rarely visible, and the pulmonic valve usually was absent. 12 Finally, intraprocedural TEE allowed real-time monitoring for early identification of iatrogenic pericardial effusion, if present.…”

“… 6 , 9 , 11 , 17 Surprisingly, in 4 of the 5 patients with LP-related pericardial effusion or tamponade, the devices were implanted in the septal position. 11 In a study by Kaczmarek et al, 16 who investigated septal implantations of LP devices, a single heart perforation occurred when a delivery sheath was directed to the free wall of the RV. Previous experience with conventional pacemakers suggests that fluoroscopy might be insufficient for guiding precise lead implantation in the IVS; therefore, use of intraprocedural TEE seems to be advisable.…”

Second Micra leadless pacemaker implantation by using intracardiac echocardiography

“…− 4 It is usually confirmed under fluoroscopy that the two Micra devices are not in close proximity and there are no mechanical interactions. Transesophageal echocardiography guidance may be considered at implantation 5 . However, in our case, ICE was a very effective tool for confirming the location of Micra implantation.…”

Atrioventricular synchronous leadless pacing: Micra AV

“…During contrast injections, a flat flow pattern against the septum in LAO 30–40° indicates optimal contact, and the contrasted trabeculated surface only reassures a good position. If doubt persists, the use of intraprocedural transesophageal echocardiography can prevent the LP’s implantation to the heart’s free wall [ 8 ].…”