Archives of cardiovascular diseases · 2020
Leadless pacemaker for patients following cardiac valve intervention.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Garweg Christophe, Vandenberk Bert, Foulon Stefaan, Poels Patricia, Haemers Peter, Ector Joris, Willems Rik
Аннотация
BACKGROUND: Permanent pacing is common after valve intervention. The presence of a conventional pacemaker in this population is recognized as a risk factor for infectious events. Therefore, a leadless pacing system could be the preferred strategy when permanent pacing is required after valve intervention.
AIM: To report periprocedural outcomes and follow-up of patients undergoing implantation of a leadless pacing system after valve intervention.
METHODS: Patients with previous valve intervention at the time of attempted implantation of a leadless pacemaker (Micra™, Medtronic, Minneapolis, MN, USA) were included, and were compared with a control group (patients also implanted with Micra™ without valve intervention).
RESULTS: Among a total of 170 Micra™ implantation procedures, 54 patients (31.8%) had a history of valve intervention: 28 after aortic valve replacement; 10 after mitral valve replacement; one after single tricuspid valvuloplasty; and 15 after multiple valve surgery. Median age of the patients was 82.5 (77.0-86.0) years and 53.7% were male. Patients with previous valve intervention had a higher incidence of arterial hypertension (P=0.014) and ischaemic heart disease (P=0.040). The primary indications for permanent pacing after valve intervention were high-degree atrioventricular block (59.3%) and atrial fibrillation with bradycardia (27.8%). Micra™ was successfully implanted in all patients (n=170) without any procedure-related major complications. During a median follow-up of 12 months, electrical performance was excellent and similar in both groups. Also, a similar reduction in left ventricular ejection fraction was observed at 12 months in both groups, which was correlated with the percentage of right ventricular pacing.
CONCLUSION: A leadless pacemaker is safe and efficient after valve intervention, and therefore represents an effective pacing option in patients after valve intervention.
AIM: To report periprocedural outcomes and follow-up of patients undergoing implantation of a leadless pacing system after valve intervention.
METHODS: Patients with previous valve intervention at the time of attempted implantation of a leadless pacemaker (Micra™, Medtronic, Minneapolis, MN, USA) were included, and were compared with a control group (patients also implanted with Micra™ without valve intervention).
RESULTS: Among a total of 170 Micra™ implantation procedures, 54 patients (31.8%) had a history of valve intervention: 28 after aortic valve replacement; 10 after mitral valve replacement; one after single tricuspid valvuloplasty; and 15 after multiple valve surgery. Median age of the patients was 82.5 (77.0-86.0) years and 53.7% were male. Patients with previous valve intervention had a higher incidence of arterial hypertension (P=0.014) and ischaemic heart disease (P=0.040). The primary indications for permanent pacing after valve intervention were high-degree atrioventricular block (59.3%) and atrial fibrillation with bradycardia (27.8%). Micra™ was successfully implanted in all patients (n=170) without any procedure-related major complications. During a median follow-up of 12 months, electrical performance was excellent and similar in both groups. Also, a similar reduction in left ventricular ejection fraction was observed at 12 months in both groups, which was correlated with the percentage of right ventricular pacing.
CONCLUSION: A leadless pacemaker is safe and efficient after valve intervention, and therefore represents an effective pacing option in patients after valve intervention.