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Safety and feasibility of a midseptal implantation technique of a leadless pacemaker.
- Source :
-
Heart rhythm [Heart Rhythm] 2019 Jun; Vol. 16 (6), pp. 896-902. Date of Electronic Publication: 2018 Dec 11. - Publication Year :
- 2019
-
Abstract
- Background: The major risk of implanting a leadless pacemaker at the right ventricular (RV) apex is cardiac perforation.<br />Objective: The purpose of this study was to describe and prospectively evaluate the safety and feasibility of a technique for midseptal implantation of the Micra leadless pacemaker.<br />Methods: We positioned the device at the center of the cardiac silhouette in the right anterior oblique (RAO) view, toward the left in the left anterior oblique (LAO) view, and away from the sternum in the left lateral view.<br />Results: Among the 51 patients (mean age 81.3 ± 9.3 years; 47% men) included in the study, 29 (57%) were >80 years old, 7 (14%) had body mass index <20 kg/m <superscript>2</superscript> , 48 (94%) had renal dysfunction, and 33 (65%) had valvular heart disease. The implantation sites were mid and apical septum in 46 (90%) and 5 (10%) patients, respectively. Although RAO and LAO views suggested a septal location, 9 (17.6%) devices were found to be directing at the free wall in the left lateral view and required repositioning. One patient (2%) developed cardiac perforation due to contrast injection against the RV anterior wall before verification of sheath location by lateral view. Mean R-wave sensing and pacing threshold at implantation were 9.7 ± 4.0 mV and 0.61 ± 0.31 V/0.24 ms, respectively. After median follow-up of 218.7 days, the pacing threshold remained stable.<br />Conclusion: In this high-risk patient cohort, midseptal implantation of a leadless pacemaker as guided by RAO, LAO, and left lateral views was achieved in 90% of patients, with a low risk of complications.<br /> (Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged, 80 and over
Electrocardiography methods
Feasibility Studies
Female
Fluoroscopy methods
Heart Ventricles injuries
Hong Kong
Humans
Male
Outcome and Process Assessment, Health Care
Risk Adjustment methods
Bradycardia diagnosis
Bradycardia surgery
Cardiac Pacing, Artificial methods
Heart Injuries etiology
Heart Injuries prevention & control
Intraoperative Complications prevention & control
Pacemaker, Artificial
Prosthesis Implantation adverse effects
Prosthesis Implantation methods
Subjects
Details
- Language :
- English
- ISSN :
- 1556-3871
- Volume :
- 16
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Heart rhythm
- Publication Type :
- Academic Journal
- Accession number :
- 30550834
- Full Text :
- https://doi.org/10.1016/j.hrthm.2018.12.007