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Leadless pacemaker: Single Centre 5 year experience
Session:
Posters (Sessão 4 - Écran 5) - Pacing
Speaker:
Rita Amador
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rita Amador; Pedro Carmo; Diogo Cavaco; João Carmo; João Presume; Ana Rita Reis Santos; Pedro Lopes; Daniel Matos; Gustavo Rodrigues; Pedro Galvão Santos; Francisco Moscoso Costa; Maria Salomé Carvalho; Francisco Morgado; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Leadless pacemakers were developed with the goal of reducing infectious pacemaker complications without compromising efficacy. The aim of this study was to evaluate the efficacy of pacing both at baseline and during follow-up in patients who had a leadless pacemaker (Micra VR<sup> TM</sup>) implanted in a real-world setting. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We conducted a single-centre retrospective study of patients receiving the Micra VR<sup> TM</sup> leadless pacemaker between 2015 and 2022. Only patients with both implantation and follow-up in our centre were included. Pacing threshold voltage and duration of impulse, impedance and R wave amplitude were recorded at baseline and at the last follow-up available in medical records for each patient. Efficacy endpoint was defined as a pacing threshold inferior to 2V and 0,24 ms of duration together with an absence of increase larger than 1.5V during follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 94 patients were included, mean age 78 ± 10 years, 66% (n = 62) male. The main indication for PM implantation in this group of patients was atrial fibrillation with a low ventricular rate (48%), followed by atrioventricular block (32%). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The median procedural duration was 33 [27 - 46] minutes, with fluoroscopy time of 3 [2 - 5] minutes. The Micra pacemaker was successfully implanted in all patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At baseline, median threshold was 0,5 [0,38 - 0,75] V with impulse duration 0,24 [0,24 - 0,24]ms. Mean impedance was 705 [620 - 888] ohm, and R wave amplitude was 9,8 [6,5 - 14,0] mV. In this group, 4 patients had an R wave amplitude at baseline lower than 5 mV. The need to replace the system arose in only 1 patient, with loss of ventricular capture less than 24h after implantation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At the last follow-up appointment (median follow-up duration 29 [9 - 46] months), median threshold was 0,5 [0,38 - 0,63] V with impulse duration 0,24 [0,24 - 0,24] ms. Mean impedance was 550 [480 - 643] ohm, and R wave amplitude was 12,1 [9,2 - 16,5] mV. Furthermore, patients with a R wave amplitude under 5 mV at baseline showed an improvement and had at follow-up an amplitude greater than 5 mV. 34 patients (36%) showed a slight reduction in threshold, 45 (48%) showed increase and 15 (%) maintained threshold. All 94 patients met the efficacy endpoint. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In out cohort with still limited follow-up, the MICRA VR<sup> TM</sup> pacemaker showed good efficacy that was maintained during follow-up. </span></span></p>
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