SPC365

Leadless pacemaker - lead parameters stability and battery longevity in the mid-term follow-up

Session: Sessão de Posters 43 - Inovações em Síncope e Pacing Cardíaco
Speaker: Joana Certo Pereira

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Cartazes
FP Number: ---
Authors: Joana Certo Pereira; Rita Amador; Francisco Moscoso Costa; Daniel A. Gomes; Rita Reis Santos; Sandra Feliciano; Gustavo Rodrigues; Pedro Galvão Santos; Pedro Carmo; Diogo Cavaco; Francisco Belo Morgado; Pedro Adragão

<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 pacemaker (L-PM) systems claim lower complications rate by avoiding the need for generator pocket and transvenous lead. Nevertheless, long-term safety will largely depend on the need for replacements, mainly due to battery depletion (end-of-life). While the mean L-PM battery longevity predicted by the manufacturer is 12 years, real-world longevity data are still scarce. We aimed to describe L-PM parameters&rsquo; stability and battery longevity during the mid-term follow-up. </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">Single-center registry of consecutive patients undergoing L-PM implantation from May 2015 to November 2023. Procedural characteristics, lead parameters and battery longevity were collected immediately after implantation and during the most recent follow-up visit. </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">Overall, 261 consecutive patients had a transcatheter L-PM implanted through a femoral vein (mean age 78&plusmn;10 years; 66% male). Mean procedural duration was 44&plusmn;28min and fluoroscopy time was 4,4&plusmn;3,9min. The device was successfully implanted in all but one patient. The main indications for permanent pacing were high-degree atrioventricular block [N=130 (50%)], atrial fibrillation with pauses [N=78 (30%)], and sinus node disease [N=28 (11%)]. Immediately after implantation, three cases (1,2%) of pericardial effusion (one with tamponade) were reported. In one case (0,4%), a conventional pacemaker was implanted due to L-PM acute dysfunction. No other procedure-related complications, including dislodgment, were reported at discharge. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After a mean follow-up of 2,8&plusmn;1,7years, the pacing threshold and R-wave amplitude remained stable [0,67mV vs. 0,62mV (p=0,9); and 10,3mV vs. 16,1mV (p&lt;0,001), respectively] and mean ventricular pacing was 54&plusmn;38%. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Expected battery longevity was &gt;8 years (maximum value) in 84% of the patients. In the subgroup of patients with &gt;5 years of follow-up (N=20; mean follow up of 6,3&plusmn;1,8years), the expected battery longevity was &gt;8 years in 85% (N=17). In three cases, the L-PM was upgraded to cardiac resynchronization therapy or left bundle branch area pacing due to pacing-induced left ventricular dysfunction. There was one case of L-PM end-of-life 6 years after implant (pacing threshold 0,5mV, with 100% ventricular pacing), in which a second L-PM was successfully implanted. Overall, 78 (31%) patients died, a mean of 2,2&plusmn;1,9 years after L-PM implantation, none related to the device.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In this real-world cohort, L-PM maintained stable pacing parameters and, in the mid-term follow-up, only one battery depletion was observed while expected longevity remained above 8 years in the large majority of patients. Longer follow up will allow better understanding of both technical and clinical aspects relevant to manage end-of-life devices.</span></span></p>