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Aguayo JA, Cortez D. Atrial placement of Aveir-VR leadless pacemaker in a patient with complex cardiac anatomy. Indian Pacing Electrophysiol J 2024:S0972-6292(24)00048-2. [PMID: 38697395 DOI: 10.1016/j.ipej.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/05/2024] Open
Abstract
Leadless pacemakers have provided new treatment modalities that can be especially useful in patients with complex cardiac anatomy and contraindications toward other pacemaker approaches. The Aveir™ single-chamber (VR) leadless pacemaker (LP) (Abbott Laboratories, Chicago, IL) is a recently approved device that can be placed in the right ventricle for patients with bradycardia. In this case, we present a novel use for the device through placement in the atrium to control atrial flutter in a patient with a hypoplastic right ventricle.
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Affiliation(s)
| | - Daniel Cortez
- Adult Congenital Cardiology, UC Davis Medical Center, Sacramento, USA.
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2
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Sherwin ED, Shah MJ. Leadless Pacemakers in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:421-432. [PMID: 37865516 DOI: 10.1016/j.ccep.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Transcatheter leadless pacemakers have benefits in congenital heart disease because they eliminate the risks of lead malfunction, venous occlusions, and pocket complications. This newest pacemaker's utility in this population has been limited by the large sheath and delivery system, need for atrioventricular synchronous pacing, lack of explantation options, and possible lack of adequate access to the subpulmonary ventricle. With careful planning, leadless pacing can be successfully performed in these patients. Consideration of nonfemoral access, alternative implant sites to avoid myocardial scar or prosthetic material, anticoagulation for patients with persistent intracardiac shunts or systemic ventricular implantation, and operator experience are critical.
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Affiliation(s)
- Elizabeth D Sherwin
- Division of Pediatric Cardiology, Children's National Hospital, Division of Cardiology Washington, 111 Michigan Avenue, NW, Washington, DC 20010, USA
| | - Maully J Shah
- Cardiac Electrophysiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Vouliotis AI, Roberts PR, Dilaveris P, Gatzoulis K, Yue A, Tsioufis K. Leadless Pacemakers: Current Achievements and Future Perspectives. Eur Cardiol 2023; 18:e49. [PMID: 37655133 PMCID: PMC10466270 DOI: 10.15420/ecr.2022.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/18/2022] [Indexed: 09/02/2023] Open
Abstract
Despite the technological advances in pacemaker technology, the transvenous implanted leads are still considered the Achilles' heel of this rhythm-control therapy. The leadless permanent pacemaker system was developed as an option to bypass the weakness of the transvenous approach. Advances in battery technology and deep miniaturisation of electronics now offer the opportunity to implant the whole pacemaker system into the right ventricle. This review aims to provide a comprehensive report on the advent of leadless pacemakers, their clinical usefulness and the future perspectives of this disruptive and promising technology. Further research is required before some of these technologies are safely and routinely used in clinical practice.
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Affiliation(s)
- Apostolos Ilias Vouliotis
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Paul R Roberts
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
| | - Polychronis Dilaveris
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Konstantinos Gatzoulis
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
| | - Arthur Yue
- Cardiology Department, University Hospital SouthamptonSouthampton, UK
| | - Konstantinos Tsioufis
- First University Department of Cardiology, School of Medicine, National and Kapodistrian University of AthensAthens, Greece
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4
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Calvert P, Yeo C, Rao A, Neequaye S, Mayhew D, Ashrafi R. Transcarotid implantation of a leadless pacemaker in a patient with Fontan circulation. HeartRhythm Case Rep 2022; 9:53-58. [PMID: 36685685 PMCID: PMC9845646 DOI: 10.1016/j.hrcr.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Peter Calvert
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Cheng Yeo
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Archana Rao
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Simon Neequaye
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Liverpool University Hospitals Foundation Trust, Royal Liverpool Hospital, Liverpool, United Kingdom
| | - David Mayhew
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Reza Ashrafi
- Liverpool Heart & Chest Hospital, Liverpool, United Kingdom,Address reprint requests and correspondence: Dr Reza Ashrafi, Northwest Congenital Heart Disease Partnership, Liverpool Heart & Chest Hospital, Thomas Dr, Liverpool, England, UK L14 3PE.
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Bassareo PP, Walsh KP. Micra pacemaker in adult congenital heart disease patients: a case series. J Cardiovasc Electrophysiol 2022; 33:2335-2343. [PMID: 36041216 DOI: 10.1111/jce.15664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/05/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION implantation of transvenous endocardial or epicardial pacemakers presents specific challenges in adult congenital heart disease (ACHD) patients. Micra leadless pacemaker (Micra PPM) may overcome some of these difficulties. METHODS 15 ACHD patients who underwent Micra PPM insertion were retrospectively evaluated. RESULTS males 53.3%. Mean age at study: 37.5±10.7 years. Mean age at Micra PPM insertion: 35.5±11.0 years. Mean follow-up so far: 2.0±0.3 years. Concerning the ACHD patients, 6.7% had a simple defect, 66.6% had a moderately complex defect, 26.7% were complex. Four patients (26.7%) had a previous PPM implantation. Three patients (20%) had a systemic right ventricle. Two patients (13.3%) had a single ventricle physiology. Five (33.3%) had Trisomy 21. The most commonly used Micra PPM modality was VVI (73.3%). Mean threshold post implantation was 0.48 V [range: 0.25-1.13 V], while mean threshold at 6 months control was 0.60 V [range: 0.38-1.13 V] (p=ns). Mean R wave post implantation was 10.3 V [range: 3.25-19.4 V], whilst mean R wave at 6 months follow-up was 10.1 V [range:3.5-19.0 V] (p=ns). No major peri and post-procedural complications were encountered. CONCLUSIONS since ACHD patients are living longer and surviving into adulthood, the incidence of conduction disorders continues to increase, as part of the natural history of some lesions or as early or late complication of surgery. The Micra leadless PPM can be successfully implanted in ACHD patients and have significant theoretical advantages. They should be considered when transvenous and epicardial pacing are either contraindicated or represent an otherwise suboptimal approach. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pier Paolo Bassareo
- University College of Dublin, School of Medicine, National Adult Congenital Heart Disease Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kevin Patrick Walsh
- University College of Dublin, School of Medicine, National Adult Congenital Heart Disease Service, Mater Misericordiae University Hospital, Dublin, Ireland
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Ezhumalai B, Singh Makkar J. Transcatheter leadless permanent pacemaker in complex congenital heart disease with interrupted inferior vena cava: A challenging implantation. Indian Pacing Electrophysiol J 2022; 22:165-168. [PMID: 35364233 PMCID: PMC9091794 DOI: 10.1016/j.ipej.2022.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
31 years lady with complete atrioventricular canal defect, large primum atrial septal defect (ASD), inlet ventricular septal defect (VSD) and Eisenmenger syndrome, presented with atrial flutter and complete heart block. She was not suitable for corrective cardiac surgery and not yet indicated for heart-lung transplantation. She was advised single chamber permanent pacemaker and eventually Micra VR transcatheter leadless pacemaker was finalised for her. Transcatheter leadless pacemaker was deployed in her RV septum despite some unforeseen technical problems. This patient had intrahepatic interruption of IVC with Azygous continuation draining into SVC but this altered venovascular course was detected only fluoroscopically midway during the pacemaker implantation procedure and this was not detected in the preprocedural transthoracic echocardiography. This abnormal venous course was clearly demonstrated in the cardiac CT which was performed only after completion of the pacemaker implantation procedure in this patient. The technical challenges encountered mainly were mostly during the manipulation of the 27F delivery catheter of Micra through this altered cardiovascular anatomy via transfemoral approach and also due to the presence of septal defects. Thus, transcatheter leadless permanent pacemaker was implanted successfully through transfemoral access in this complex congenital heart disease with interrupted IVC and azygous continuation. Besides transthoracic echocardiography, it may be better to perform transesophageal echocardiography or even preferably radiological imaging like cardiac CT or MRI prior to transcatheter leadless pacemaker implantation in patients with complex congenital heart disease to understand the cardiovascular anatomy and plan the procedure.
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Affiliation(s)
- Babu Ezhumalai
- Department of Cardiology, Fortis Malar Hospital, Chennai, India.
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Kautzner J, Wunschova H, Haskova J. Leadless pacemaker implant guided by intracardiac echocardiography in a patient after Mustard repair. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:571-573. [PMID: 34850401 DOI: 10.1111/pace.14417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
This case report describes a successful leadless pacemaker implant (Micra VR Medtronic, Inc, Minneapolis, MN) in a 48-year-old patient with a history of Mustard repair. Twenty-one years after dual-chamber pacemaker implant, both conventional leads became dysfunctional. Lead extraction was refused by the patient and the subclavian vein was obstructed. A leadless pacemaker was selected as an alternative. Intracardiac echocardiography allowed the safe introduction of the delivery system into the non-systemic left ventricle. Four months after implant, the pacing parameters are stable and the patient is without new complaints. A leadless pacemaker could be considered in patients with complex grown-up congenital heart disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hanka Wunschova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Haskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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D'Arienzo G, Sicuranza M, Ziccardi L, Di Biase M, Brunetti ND. Leadless implantation as alternative for pacemaker replacement in infiltrative breast cancer. J Cardiovasc Med (Hagerstown) 2021; 22:222-224. [PMID: 33512976 DOI: 10.2459/jcm.0000000000001026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Monica Sicuranza
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Luigi Ziccardi
- Cardiology Department, Ospedali Riuniti University Hospital
| | - Matteo Di Biase
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
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Siddeek H, Jimenez E, Ambrose M, Braunlin E, Steinberger J, Bass J, Cortez D. Pediatric Micra leadless pacemaker implantation via internal jugular and femoral vein: a single center, US experience. Future Cardiol 2021; 17:1116-1122. [PMID: 33463371 DOI: 10.2217/fca-2020-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In the pediatric population, conventional transvenous and epicardial pacemaker systems carry complications such as lead distortion due to growth/activity, in addition to other lead/pocket complications. Materials & methods: A retrospective review of pediatric leadless pacing at the University of Minnesota Masonic Children's Hospital from 2018 to 2020 was performed. Rationale for pacing, demographics of patients, thresholds and longevity of devices were recorded. Results: Seven leadless pacemaker insertions and one removal were performed successfully, in patients weighing between 19 kg and 58 kg. Three patients had Micra implantation via internal jugular vein. One pericardial effusion occurred perioperatively in a 19 kg patient with baseline thrombocytopenia, sideroblastic anemia and Pearson Marrow Pancreas syndrome. Conclusion: Leadless pacemaker implantation/early retrieval is feasible in pediatric patients.
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Affiliation(s)
- Hani Siddeek
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Erick Jimenez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Matthew Ambrose
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Elizabeth Braunlin
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Julia Steinberger
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - John Bass
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Daniel Cortez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA.,Clinical Sciences, Lunds University, Lund, Sweden
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Nakamura K, Sasaki T, Minami K, Take Y, Naito S. Halo-shape technique for leadless pacemaker implantations: A case report. Indian Pacing Electrophysiol J 2020; 21:65-66. [PMID: 33075483 PMCID: PMC7854376 DOI: 10.1016/j.ipej.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
A 92-year-old woman underwent an implantation of a leadless pacemaker (Micra; Medtronic, Inc, Minneapolis, MN) for complete atrioventricular block after a transvenous lead extraction due to a pocket infection of a dual chamber pacemaker. Marked scoliosis and a humpback due to an advanced age made it impossible to direct the tip of the pacemaker delivery catheter towards the right ventricular septum or apex and shape the catheter into a gooseneck-shape. Thus, by attaining a halo-catheter shape of the delivery catheter, the catheter tip could be directed toward the infero-basal portion of the right ventricular septum. The pacemaker was successfully deployed at that site without any complications, and good device parameters were achieved. The halo-shape technique may be also an alternative method for delivering a leadless pacemaker in patients with an unsuccessful delivery of a leadless pacemaker to the right ventricular septum using the conventional gooseneck-shape technique.
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Affiliation(s)
- Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Kentaro Minami
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan
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11
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Dunne L, Breatnach C, Walsh KP. Systemic ventricular implantation of a leadless pacemaker in a patient with a univentricular heart and atrioventricular node calcification. HeartRhythm Case Rep 2020; 6:265-267. [PMID: 32461891 PMCID: PMC7244624 DOI: 10.1016/j.hrcr.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Colm Breatnach
- Children's Health Ireland (CHI) Crumlin, Dublin, Ireland
| | - Kevin P Walsh
- Children's Health Ireland (CHI) Crumlin, Dublin, Ireland.,Beacon Hospital, Dublin, Ireland.,The Mater Misericordiae University Hospital, Dublin, Ireland
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12
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Russell MR, Galloti R, Moore JP. Initial experience with transcatheter pacemaker implantation for adults with congenital heart disease. J Cardiovasc Electrophysiol 2019; 30:1362-1366. [DOI: 10.1111/jce.13961] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/12/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew R Russell
- Division of Pediatric CardiologyDepartment of PediatricsUniversity of California Los Angeles California
| | - Roberto Galloti
- Division of Pediatric CardiologyDepartment of PediatricsUniversity of California Los Angeles California
| | - Jeremy P Moore
- Division of Pediatric CardiologyDepartment of PediatricsUniversity of California Los Angeles California
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center Los Angeles California
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13
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Alyesh D, Cunnane R. Successful leadless pacemaker deployment in a patient with challenging right heart anatomy using a double snare technique. HeartRhythm Case Rep 2018; 5:399-401. [PMID: 31453088 PMCID: PMC6702130 DOI: 10.1016/j.hrcr.2018.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Daniel Alyesh
- Section of Electrophysiology, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Ryan Cunnane
- Section of Electrophysiology, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan
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