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Atrioventricular-synchronous leadless pacemakers: a single center experience
Session:
Comunicações Orais - Sessão 08 - Dispositivos em Arritmologia
Speaker:
Rita Reis Santos
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Reis Santos; Daniel Gomes; Diogo Cavaco; João Carmo; Mariana S. Paiva; Pedro M. Lopes; Daniel N. Matos; Gustavo R. Rodrigues; Maria Salomé Carvalho; Francisco M. Costa; Pedro Galvão Santos; Pedro Carmo; Francisco B. Morgado; Pedro Adragão
Abstract
<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">Background:</span></span></span></strong><span style="font-size:11pt"><span style="color:black"><span style="background-color:white"> Leadless pacemakers allow </span></span></span><span style="font-size:11pt">atrioventricular (AV) synchronous pacing </span><span style="font-size:11pt">using a new software to detect atrial contraction with a 3-axis accelerometer. Notwithstanding, evidence supporting its use is still scarce and only limited real-world data have been reported. </span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Aim:</span></strong><span style="font-size:11pt"> To evaluate the </span><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">feasibility and to describe pacing outcomes of AV-synchronous leadless pacemakers. </span></span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Methods:</span></strong><span style="font-size:11pt"> Consecutive patients with AV block referred to leadless pacemaker Micra<sup>TM</sup> at single center between </span><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">June 2020 and November 2022 were retrospectively included. Patients were evaluated at two distinct times during follow-up and parameters from </span></span></span><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">sensed atrial tracking were calculated: </span></span></span><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">tracking index (atrial mechanical sense followed by ventricular pace [AM-VP] divided by total VP) and total AV synchrony (sum of AM-ventricular sense [AM-VS], AM-VP, and AV conduction mode switch). </span></span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">Results:</span></span></span></strong><span style="font-size:11pt"><span style="color:black"><span style="background-color:white"> A total of 43 patients (mean age 78 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:black"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="color:black"><span style="background-color:white"> 11 years; 72% male) were included. Pacing indication was complete AV block </span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white">in 29 patients (67%) and high-grade AV block in the remaining 14 (33%). Mean implantation and fluoroscopy times were 48 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#0d0d0d"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white"> 22 minutes and 4.5 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#0d0d0d"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white"> 3.9 minutes, respectively. One major peri-procedural complication was reported: a cardiac tamponade, treated with pericardiocentesis. The first outpatient visit occurred at a mean follow-up of 3.2 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#0d0d0d"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white"> 4.1 months after the implantation procedure. Overall, at the first screening, 47% of patients required at least 50% pacing; mean tracking index was 65 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#0d0d0d"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white"> 16% and mean total AV synchrony was 80 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#0d0d0d"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white"> 18%. Specific pacemaker parameters were adjusted according to physician’s </span></span></span><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">discretion, </span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white">namely A3 and A4 thresholds and A3 window. Thirty-seven patients performed 2 follow-up visits, 8 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#0d0d0d"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white"> 5 months after the first visit. In comparative analysis between both follow up times, </span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d">mean total AV synchrony remained stable (80 ± 17% vs. 80 ± 15%, p=0.970) and there was a numerical improvement of tracking index by 6 </span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#0d0d0d"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white"> 13%</span></span></span><span style="font-size:11pt"><span style="color:#0d0d0d"> (65 ± 15% vs. 71 ± 16%, p=0,059). </span></span><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white">During the follow-up, 7 patients (16%) died, none related to the procedure nor the device.</span></span></span></span></span></span></p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:#0d0d0d"><span style="background-color:white">Conclusions: </span></span></span></strong><span style="font-size:11pt"><span style="color:#0d0d0d">Implantation of </span></span><span style="font-size:11pt"><span style="color:#0d0d0d">AV-synchronous </span></span><span style="font-size:11pt"><span style="color:#0d0d0d">leadless pacemakers is feasible and safe. In our cohort, there was a</span></span><span style="font-size:11pt"><span style="color:#0d0d0d">numerical increased of atrial tracking and a stability of AV synchrony during follow-up.</span></span></span></span></span></p>
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