PO-04-147 LEADLESS PACING IN ADULT CONGENITAL HEART DISEASE PATIENTS: MULTI-CENTRE UK EXPERIENCE

Abstract

A significant number of Adults with Congenital Heart Disease (ACHD) require cardiac rhythm management devices. Implantation of endocardial or epicardial pacemakers presents specific challenges in this population. The Micra leadless pacemakers have potential to overcome some of these challenges. To assess the utility of Micra implant in ACHD population. A retrospective analyses of Micra implants undertaken at Barts Heart Centre, London and Liverpool Heart and Chest Hospital in the ACHD population between 2020-2022. Data was collected from a prospective registry and electronic health records. Patients were contacted for follow-up data where necessary. 26 AV Micras were implanted across the two centres over two years. 52% females with mean age of 37 yrs. 42% were anticoagulated with warfarin or a DOAC. Underlying etiology – Figure 1. Micra indication – Table 1. Mean procedure and fluoroscopy times were 57±21min and 7±1 min. Access site was femoral in 77% and transjugular in 23%. Mean sensing and thresholds were 11±0.4mV and 0.6±0.09V at 0.24ms respectively. There were no acute procedural complications. Over a mean follow-up of 13 months there were no significant programming issues or change in pacing parameters. One patient had high thresholds and one died of non-cardiac causes. Micra implants should be considered in cases where endocardial or epicardial implants are contraindicated or represent an otherwise suboptimal approach. They have advantages in ACHD patients with complex cardiac anatomy, difficult venous access and need for repeat procedures. Larger multicentre studies and longer follow-ups are required.Tabled 1Table 1Micra Indicationn, %Failed endocardial system6,23Failed epicardial system6,23Bridge to CRTP3,12SVC occlusion3,12Other8,30 Open table in a new tab