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Mid-term performance of the Micra transcatheter pacemaker in patients on chronic hemodialysis
Session:
Posters 1 - Écran 3 - Arritmologia
Speaker:
Pedro Silva Cunha
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Posters
FP Number:
---
Authors:
Pedro Silva Cunha; Pedro Garcia Brás; Bruno Tereno Valente; Guilherme Portugal; Ana Sofia Delgado; Manuel Brás; Nuno Monteiro; Alice Gonçalves; Susana Covas; Rui Cruz Ferreira; Mário Martins Oliveira
Abstract
<p>Bradyarrhythmias are frequently encountered in hemodialysis patients (P) and treated with implantable transvenous pacemakers. However, this population presents a higher risk of infection and central venous stenosis/occlusion with conventional trasnvenous devices. The technological advancement of a leadless pacemaker (LPM) provides an opportunity to implement a strategy to prevent these complications. Weather the electrical performance of LPM differ upon these P has not been examined. <strong>Aim:</strong>to evaluate the acute and chronic performance of the Micra transcatheter LPM from a group of P with end stage renal disease (ESRD) and chronic hemodialysis (CH). <strong>Methods: </strong>ConsecutiveP treated, undergoing a Micra LPM implant, with at least 6 months follow-up. Electrical performance in the acute setting at implantation and during follow-up was characterized. Data was analyzed at implant, before discharge, 6 weeks and 6 months after implant, and yearly, thereafter. <strong>Results:</strong>A total of 14P were considered; 8 of these had ESRD and chronic hemodialysis. </p> <p>8 Patients (1female), with 75,6 ± 7,9 years old. All had indications for a ventricular demand (VVI) pacemaker, and normal ejection fraction. One P were under immunosupressive therapy due to heart transplant and 3 P with previous CABG, 1 P had amputation of right inferior limb. </p> <p>The average creatinine value was 5,6 +/- 1,29 mg/dl. All LPM were implanted via the right femoral vein, and deployed either at the right ventricular apex (4) or at the interventricular septum (4). At implantation, average pacing threshold was 1,05 ± 0.59V (range 0,25-2,38) at 0.24ms, and R wave was 8,4 ± 3,6 mV. </p> <p>Successful pacing sites were reached at a median of 2 attempts (range 1-4), There were no acute complications, including groin hematoma or hemorrhage. Pacing threshold improved at 1 month compared to acute implant values (0.78 ± 0.37 V). Between 6 and 9 months follow-up, there were no changes in pacing or sensing parameters. At a follow-up of 21,1 +/- 10,8 months, there were 3 deaths (37,5%), 2 related to pneumonia, and 1 gastrointestinal bleeding due to chronic hepatic disease. <strong>Conclusions:</strong>This initial experience in candidates for ventricular pacing on chronic hemodialysis and with a particularly high-risk for complications, documents an excellent implantation success of the Micra™ LPM with stable pacing and sensing and no acute or short-term follow-up complications related to the pacing system. This population of patients has a high mortality rate, probably related to the advanced age and presence of co-morbidities. </p>
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