The Safety and Feasibility of Same-Day Discharge After Implantation of MICRA Transcatheter Leadless Pacemaker System

Abstract

Background : Data suggests that same day discharge after implantation of trans-venous pacemakers is safe and feasible. We sought to determine whether same day discharge was feasible and safe following implantation of Medtronic MICRA leadless pacemakers. Methods : We retrospectively identified all patients undergoing MICRA placement at our institution between April 2014 to August 2018 (n=167). Patients were stratified into two groups: those discharged on the same day as their procedure (SD, n=25), and those observed for at least one night in the hospital (HD, n=142). The primary endpoint included a composite of major complications including: access site complications, new pericardial effusion, device dislodgement, and need for device revision up to approximately 45 days of follow up. Results : SD and HD had similar age (75±13 vs. 75±13 years, p=0.923), prevalence of male sex (49 vs. 44%, p=0.669), and frequency of high-grade heart block as an indication for pacing (38 vs. 32%, p=0.596). There were more Caucasians in the SD group (72 vs. 66%, p=0.038). The rate of the composite endpoint was statistically non-significantly higher in the HD group (3.5% vs. 0.0%, p=1.00). The rates of each individual components comprising the composite endpoint were similar between groups. Conclusions : Our data suggest that in appropriately selected patients, same day discharge can occur safely following Micra leadless pacemaker implantation.

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

“…According to the clinical practice, patients are discharged 24-48 h after a traditional transvenous pacemaker implant. In case of leadless PM, data suggest that in appropriately selected patients, same day discharge can occur safely following M-TPS implantation [16]. Authors did not identify any difference in major complications, including problems with device function, procedural and access complications, between those discharged on the day of the procedure compared to those discharged after a traditional overnight hospital stay.…”

Same‐day discharge after implantation of cardiac implantable electronic devices: A systematic review and meta‐analysis

“…Outcomes regarding wound problems were available in three studies. 17,19,21 Wound problems occurred 0.94%, and 1.84% in SDD and HO groups respectively. There were no statistically significant differences in rates of wound problems including wound infection between SDD and HO groups (pooled shown in Figure 2A.…”

“…A total of eight studies from 2012 to June 2020 were included in this meta-analysis. [16][17][18][19][20][21][22][23] There were 1 RCT, three prospective cohort studies, and four retrospective cohort studies. The final analysis included a total of 61,602 patients (4,153 in SDD group and 57,449 in HO group) with a follow-up time range from 0.5 to 16 months.…”

“…The forest plot is shown in Figure 2B. Outcomes regarding hematoma were available in 3 studies, 17,19,20 but only 2 were available for analysis as the study by Nelson et al described 0 events in both groups. Hematoma rates were 0.59% and 2.32% in SDD and HO groups respectively.…”

“…Outcomes regarding lead/device dislodgement were available in three studies. [19][20][21] Lead/device dislodgement rates were 4% and 2.48% in SDD and HO groups respectively. Again, there were no statistically significant differences in rates of lead/device dislodgement between SDD and HO groups (pooled OR = 1.71, 95%CI: 0.64-4.54, p = .281, I 2 = 0%).…”