Leadless pacemaker for patients following cardiac valve intervention

Christophe Garweg; Bert Vandenberk; Stefaan Foulon; Patricia Poels; Peter Haemers; Joris Ector; Rik Willems

doi:10.1016/j.acvd.2020.05.012

Leadless pacemaker for patients following cardiac valve intervention

Arch Cardiovasc Dis. 2020 Dec;113(12):772-779. doi: 10.1016/j.acvd.2020.05.012. Epub 2020 Sep 2.

Authors

Christophe Garweg¹, Bert Vandenberk², Stefaan Foulon³, Patricia Poels³, Peter Haemers², Joris Ector², Rik Willems²

Affiliations

¹ Department of Cardiovascular Sciences, University of Leuven, 3000 Leuven, Belgium; Cardiology, University Hospitals of Leuven, 3000 Leuven, Belgium. Electronic address: [email protected].
² Department of Cardiovascular Sciences, University of Leuven, 3000 Leuven, Belgium; Cardiology, University Hospitals of Leuven, 3000 Leuven, Belgium.
³ Cardiology, University Hospitals of Leuven, 3000 Leuven, Belgium.

PMID: 32891563
DOI: 10.1016/j.acvd.2020.05.012

Abstract

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.

Keywords: Chirurgie valvulaire ;TAVI; Leadless pacing; Micra™; Stimulateur cardiaque sans sonde; TAVI; Valve surgery.

MeSH terms

Aged
Aged, 80 and over
Arrhythmias, Cardiac / diagnosis
Arrhythmias, Cardiac / etiology
Arrhythmias, Cardiac / physiopathology
Arrhythmias, Cardiac / therapy*
Cardiac Pacing, Artificial* / adverse effects
Cardiac Valve Annuloplasty* / adverse effects
Cardiac Valve Annuloplasty* / instrumentation
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valve Prosthesis Implantation* / instrumentation
Heart Valves / diagnostic imaging
Heart Valves / physiopathology
Heart Valves / surgery*
Humans
Male
Pacemaker, Artificial*
Prospective Studies
Prosthesis Design
Transcatheter Aortic Valve Replacement
Treatment Outcome