Abstract
Background and objectives: Leadless pacemakers are less invasive but are as effective as conventional pacemakers and are increasingly implanted in elderly patients. However, the implantation procedure is sometimes challenging in patients with abnormal anatomy, particularly those with an enlarged right heart. We aimed to determine the right heart parameters that were associated with longer procedure times for leadless pacemaker implantation. Materials and Methods: Among 19 consecutive patients in whom Micra leadless pacemakers (Micra TPS, Medtronic, Minneapolis, MN) were implanted, the diameter and area of both the right atrium and right ventricle were measured by transthoracic echocardiography before the procedure. The right heart parameters that were associated with a procedure time > 60 min were investigated. Results: In the 19 patients (median 81 years old, 10 male) who underwent implantation of the Micra system, 6 (32%) required a procedure time > 60 min. Among the baseline right heart echocardiographic parameters, right atrial diameter and area were significantly associated with a procedure time > 60 min (odds ratio 11.3, 95% confidence interval 1.09–1.17, p = 0.042; and odds ratio 1.57, 95% confidence interval 1.05–2.34, p = 0.029, respectively) at a cutoff of 4.0 cm and 17.0 cm2, respectively. Conclusions: Patients with an enlarged right atrium may not be good candidates for leadless pacemakers given the longer procedure time, and conventional pacemakers should perhaps be recommended as an alternative.
Highlights
The Micra system (Micra TPS, Medtronic, Minneapolis, MN), which is the first leadless pacemaker, is a lead- and pocket-less implantable device having a high successful implantation rate (99.2%), a low incidence of complications (4%), and a 93.3% 6-month freedom from serious adverse events [1,2,3,4]
Sex, body mass index, atrial fibrillation indication, hypertension, chronic obstructive pulmonary disease, and dialysis, all of which have been reported as risk factors for Micra system-associated complications, were statistically not significantly different between the two groups stratified by the procedure time [3]
Right Heart Parameters and the Procedure Time Echocardiographic right heart parameters obtained before the procedures were analyzed in the logistic regression
Summary
The Micra system (Micra TPS, Medtronic, Minneapolis, MN), which is the first leadless pacemaker, is a lead- and pocket-less implantable device having a high successful implantation rate (99.2%), a low incidence of complications (4%), and a 93.3% 6-month freedom from serious adverse events [1,2,3,4]. A conventional pacemaker was successfully implanted via the subclavian vein Another team reported a challenging case for leadless pacemaker implantation with an enlarged right heart [7]. There have been few studies investigating right heart anatomical parameters associating with longer procedure time Such data would be useful in determining the optimal therapeutic strategy, i.e., a Micra system or conventional pacemaker, for each patient. The present study aimed to investigate echocardiographic parameters associating with a longer procedure time for implanting the Micra leadless pacemaker. Materials and Methods: Among 19 consecutive patients in whom Micra leadless pacemakers (Micra TPS, Medtronic, Minneapolis, MN) were implanted, the diameter and area of both the right atrium and right ventricle were measured by transthoracic echocardiography before the procedure. Conclusions: Patients with an enlarged right atrium may not be good candidates for leadless pacemakers given the longer procedure time, and conventional pacemakers should perhaps be recommended as an alternative
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