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Chatani R, Tasaka H, Yoshida K, Yoshino M, Kadota K. Noncontrast leadless pacemaker implantation under intracardiac echocardiography by the trans-opposite femoral vein approach guide. J Interv Card Electrophysiol 2024; 67:693-694. [PMID: 37897537 DOI: 10.1007/s10840-023-01672-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Ryuki Chatani
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Hiroshi Tasaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kenta Yoshida
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Mitsuru Yoshino
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
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Lin YS, Wu LS, Ho WC, Lai CS, Su W, Chu PH. Leadless pacemaker implementation at the right atrial appendage apex: An initial preclinical assessment. Pacing Clin Electrophysiol 2024. [PMID: 38809030 DOI: 10.1111/pace.15003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/26/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This study evaluates the feasibility and efficacy of implanting a leadless pacemaker at the right atrial appendage (RAA) in a preclinical minipig model, aiming to address the limitations of atrial pacing with current leadless devices like the Medtronic Micra, which is typically used for right ventricular implantation. METHODS Four minipigs, each with a median body weight of 45.8 ± 10.0 kg, underwent placement of the Micra transcatheter pacing system (TPS) via the right femoral vein into the RAA apex. The pacing performance was assessed over 1-week (short-term) and 3-month (long-term) periods. OUTCOMES The initial findings indicated successful implantation, with satisfactory intrinsic R-wave amplitudes and pacing threshold. In the following period, the sensitivity, threshold, and impedance were stable with time. Notably, upon explanation at 3 months, a deep myocardial penetration by the device was observed, necessitating a redesign for safe long-term use in a growing subject's heart. CONCLUSION While initial results suggest that RAA apex placement of the Micra TPS is promising for potential inclusion in a dual-chamber pacing system, the issue of myocardial penetration highlights the need for device redesign to ensure safety and effectiveness in long-term applications.
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Affiliation(s)
- Yu-Sheng Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan., Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Lung-Sheng Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan., Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wan-Chun Ho
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan., Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chao-Sung Lai
- Department of Electronics Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Wilber Su
- Internal Medicine, Banner-University Medical Center Phoenix, Phoenix, USA
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan., Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Tanabe K, Gilliland S. Perioperative Considerations for Modern Leadless Pacemakers. Semin Cardiothorac Vasc Anesth 2024; 28:38-46. [PMID: 38284295 DOI: 10.1177/10892532241230368] [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: 01/30/2024]
Abstract
Since their initial approval by the Food and Drug Administration in 2016, leadless pacemakers have become increasingly prevalent. This growth has been driven by an improved adverse effect profile when compared to traditional pacemakers, including lower rates of infection, as well as eliminated risk of pocket hematoma and lead complications. More recently, technology enabling leadless synchronized atrioventricular pacing in patients with atrioventricular block has vastly expanded the indications for these devices. Anesthesiologists will increasingly be relied upon to safely care for patients with leadless pacemakers undergoing non-electrophysiology procedures and surgery. This article provides an overview of the technology, evidence base, current indications, and unique perioperative considerations for leadless pacemakers.
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Affiliation(s)
- Kenji Tanabe
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samuel Gilliland
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
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Pipilas D, Frankel DS, Khurshid S. Pacing-induced cardiomyopathy after leadless pacemaker implant: It's all about location, location, location. J Cardiovasc Electrophysiol 2023; 34:1427-1430. [PMID: 37245077 DOI: 10.1111/jce.15944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Daniel Pipilas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shaan Khurshid
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, Massachusetts, USA
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Tong F, Sun Z. Strategies for Safe Implantation and Effective Performance of Single-Chamber and Dual-Chamber Leadless Pacemakers. J Clin Med 2023; 12:jcm12072454. [PMID: 37048538 PMCID: PMC10094832 DOI: 10.3390/jcm12072454] [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: 01/03/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
Leadless pacemakers (LPMs) have emerged as an alternative to conventional transvenous pacemakers to eliminate the complications associated with leads and subcutaneous pockets. However, LPMs still present with complications, such as cardiac perforation, dislodgment, vascular complications, infection, and tricuspid valve regurgitation. Furthermore, the efficacy of the leadless VDD LPMs is influenced by the unachievable 100% atrioventricular synchrony. In this article, we review the available data on the strategy selection, including appropriate patient selection, procedure techniques, device design, and post-implant programming, to minimize the complication rate and maximize the efficacy, and we summarize the clinical settings in which a choice must be made between VVI LPMs, VDD LPMs, or conventional transvenous pacemakers. In addition, we provide an outlook for the technology for the realization of true dual-chamber leadless and battery-less pacemakers.
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Affiliation(s)
- Fei Tong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Inoue N, Iwashima S, Morikawa S. Comparison of cardiac function before and after Micra implantation using pool scintigraphy and myocardial work: A case report. Radiol Case Rep 2022; 18:639-642. [PMCID: PMC9719007 DOI: 10.1016/j.radcr.2022.11.008] [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: 10/19/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
Leadless pacemakers, specifically Micra (Medtronic), have recently become a preferred alternative to transvenous pacemakers for use in bradyarrhythmia. Problems with conventional transvenous pacemakers include wound infection, lead disconnection, and tricuspid valve dysfunction. While Micra has the advantage of not being associated with the aforementioned complications, there have been reports of cardiac injury during Micra implantation, which have raised safety concerns. Many reports have evaluated Micra safety, but its effect on cardiac function remains unclear. In an 85-year-old man with bradycardic atrial fibrillation, a heart rate of approximately 35 bpm, and symptoms of dizziness, we analyzed ventricular workload, ejection fraction of the left and right ventricles, and inter/intraventricular synchrony using cardiac blood pool scintigraphy and myocardial work. Micra was successfully implanted into the right ventricular septum via the left femoral vein. A follow-up, 2 days later, showed no major complications associated with Micra pacing threshold and impedance. At this time, there was no apparent worsening of heart failure. Micra implantation for bradycardic atrial fibrillation has the potential to improve left ventricular work efficiency without the loss of ventricular synchrony.
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Affiliation(s)
- Naoya Inoue
- Department of Cardiology, Chutoen General Medical Center, 1-1 Shobugaike, Kakegawa, Shizuoka, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
- Corresponding author.
| | - Satoru Iwashima
- Department of Pediatrics, Chutoen General Medical Center, 1-1 Shobugaike, Kakegawa, Shizuoka, Japan
| | - Shuji Morikawa
- Department of Cardiology, Chutoen General Medical Center, 1-1 Shobugaike, Kakegawa, Shizuoka, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Shah RS, Davidson WR, Samii SM. Leadless pacemaker implantation in a subpulmonic left ventricle in a patient with congenitally corrected transposition of the great arteries. HeartRhythm Case Rep 2022; 8:471-474. [PMID: 35860776 PMCID: PMC9289060 DOI: 10.1016/j.hrcr.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Martinez-Sande JL, Gonzalez-Melchor L, Garcia-Seara J, Rodriguez-Mañero M, Fernandez-Lopez XA, Gonzalez Juanatey JR. Leadless pacemaker implantation with hybrid image mapping technique in a congenital heart disease case. HeartRhythm Case Rep 2021; 7:797-800. [PMID: 34987962 PMCID: PMC8695296 DOI: 10.1016/j.hrcr.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Laila Gonzalez-Melchor
- Address reprint requests and correspondence: Dr Laila Gonzalez-Melchor, University Clinical Hospital of Santiago de Compostela, CIBER-CV, Travesia de Choupana s/n, 15706 Santiago de Compostela, Spain.
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Kataoka N, Imamura T, Koi T, Ueno H, Kinugawa K. The Large Right Heart Is Associated with the Prolongation of the Procedure Time of Leadless Pacemaker Implantation. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:685. [PMID: 34356966 PMCID: PMC8306467 DOI: 10.3390/medicina57070685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
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.
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Affiliation(s)
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (N.K.); (T.K.); (H.U.); (K.K.)
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