Micra AV leadless pacemaker implantation after transcatheter aortic valve implantation

Background: Transvenous pacemaker (PM) implantation is a complication in patients undergoing transcatheter aortic valve implantation (TAVI). Recently, a second generation of leadless PMs able of atrioventricular (AV) synchronous pacing has been introduced and could be an alternative when ventricular pacing is required after TAVI. Real-world data on Micra AV after TAVI are still lacking. Our aim was to determine the per- and post-procedural outcomes in patients with Micra AV leadless PM implantation after TAVI.

Methods: A total of 20 consecutive patients underwent Micra AV leadless PM implantation after TAVI between November 2020 and June 2021.

Results: The main indication for ventricular pacing was high-degree AV block (55% of patients) and left bundle branch block (LBBB) associated with prolonged HV interval (45% of patients). At discharge, mean (SD) ventricular pacing threshold was 0.397 ± 0.11 V at 0.24 ms and ventricular impedance was 709.4 ± 139.1 Ω. At 1-month follow-up, 95% of patients were programmed in VDD pacing mode. Mean (SD) ventricular pacing threshold was 0.448 ± 0.094 V at 0.24 ms. In patients with ventricular> pacing > 90% (n = 5), mean AM-VP was 72.5% ± 8.3%. Pacing threshold at 1 month was not significantly different compared to discharge (p = .1088). Mean (SD) impedance was 631.0 ± 111.9 Ω, which remained stable at discharge (p = .0813). No procedural complications occurred during implantation. At 1-month follow-up, two patients displayed atrial under-sensing.

Conclusions: Micra AV leadless PM implantation after TAVI is associated with a low complication rate and good device performance at 1-month post-implantation.