Real-world experience with leadless cardiac pacing

Vaibhav R. Vaidya, Mingyan Dai, Samuel J Asirvatham, Robert F. Rea, Trena M. Thome, Komandoor Srivathsan, Siva Mulpuru, Fred Kusumoto, Kalpathi L. Venkatachalam, James D. Ryan, Paul Andrew Friedman, Yong-Mei Cha

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Leadless cardiac pacing (LCP) has emerged as a new modality for permanent pacing. We sought to describe comparative outcomes between LCP and transvenous pacemakers. Methods: Patients receiving LCP (Micra [Medtronic, Minneapolis, MN, USA] and Nanostim [St. Jude Medical/Abbott Laboratories, Chicago, IL, USA]) between 2014 and 2017 at the Mayo Clinic Heart Rhythm Enterprise practice (Rochester, MN, USA; Jacksonville, FL, USA; and Scottsdale, AZ, USA) were identified. We identified 1:1 age- and sex-matched controls receiving single-chamber transvenous ventricular pacemakers (TVP). Statistical analyses were performed with JMP 13.0.0 (SAS, Institute Cary, NC, USA). Results: Ninety patients underwent LCP implantation (73 Micra and 17 Nanostim) with a median follow-up duration of 62 (interquartile range 28-169) days. Both groups had 100% successful device implant rates. There were no differences in procedure-related major (0% vs 1%) or minor complications (8% vs 3%) in the LCP versus TVP groups (P > 0.05). Excluding Nanostim patients, there was a lower rate of device-related revision or extraction in the Micra versus TVP groups (0% vs 5%, P = 0.028). Device endocarditis was more common in the TVP group (0% vs 3%, P = 0.04). Estimated longevity was greater for the LCP group (median 12.0 vs 10.0 years, P < 0.0001). An increase in severity of tricuspid valve regurgitation (TR) by ≥2 grades occurred in none of the LCP patients, and in 19% of the TVP patients (P = 0.017). Conclusion: There are no significant differences in procedural complications among patients receiving LCP versus TVP. The Micra group had lower rates of device-related revision/extraction compared to the TVP group. Patients with leadless pacemaker were less likely to develop endocarditis or worsening TR.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StatePublished - Jan 1 2019

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Tricuspid Valve Insufficiency
Equipment and Supplies
Endocarditis

Keywords

  • endocarditis
  • leadless cardiac pacemaker
  • transvenous pacemaker
  • tricuspid regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Real-world experience with leadless cardiac pacing. / Vaidya, Vaibhav R.; Dai, Mingyan; Asirvatham, Samuel J; Rea, Robert F.; Thome, Trena M.; Srivathsan, Komandoor; Mulpuru, Siva; Kusumoto, Fred; Venkatachalam, Kalpathi L.; Ryan, James D.; Friedman, Paul Andrew; Cha, Yong-Mei.

In: PACE - Pacing and Clinical Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Vaidya, Vaibhav R. ; Dai, Mingyan ; Asirvatham, Samuel J ; Rea, Robert F. ; Thome, Trena M. ; Srivathsan, Komandoor ; Mulpuru, Siva ; Kusumoto, Fred ; Venkatachalam, Kalpathi L. ; Ryan, James D. ; Friedman, Paul Andrew ; Cha, Yong-Mei. / Real-world experience with leadless cardiac pacing. In: PACE - Pacing and Clinical Electrophysiology. 2019.
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T1 - Real-world experience with leadless cardiac pacing

AU - Vaidya, Vaibhav R.

AU - Dai, Mingyan

AU - Asirvatham, Samuel J

AU - Rea, Robert F.

AU - Thome, Trena M.

AU - Srivathsan, Komandoor

AU - Mulpuru, Siva

AU - Kusumoto, Fred

AU - Venkatachalam, Kalpathi L.

AU - Ryan, James D.

AU - Friedman, Paul Andrew

AU - Cha, Yong-Mei

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Leadless cardiac pacing (LCP) has emerged as a new modality for permanent pacing. We sought to describe comparative outcomes between LCP and transvenous pacemakers. Methods: Patients receiving LCP (Micra [Medtronic, Minneapolis, MN, USA] and Nanostim [St. Jude Medical/Abbott Laboratories, Chicago, IL, USA]) between 2014 and 2017 at the Mayo Clinic Heart Rhythm Enterprise practice (Rochester, MN, USA; Jacksonville, FL, USA; and Scottsdale, AZ, USA) were identified. We identified 1:1 age- and sex-matched controls receiving single-chamber transvenous ventricular pacemakers (TVP). Statistical analyses were performed with JMP 13.0.0 (SAS, Institute Cary, NC, USA). Results: Ninety patients underwent LCP implantation (73 Micra and 17 Nanostim) with a median follow-up duration of 62 (interquartile range 28-169) days. Both groups had 100% successful device implant rates. There were no differences in procedure-related major (0% vs 1%) or minor complications (8% vs 3%) in the LCP versus TVP groups (P > 0.05). Excluding Nanostim patients, there was a lower rate of device-related revision or extraction in the Micra versus TVP groups (0% vs 5%, P = 0.028). Device endocarditis was more common in the TVP group (0% vs 3%, P = 0.04). Estimated longevity was greater for the LCP group (median 12.0 vs 10.0 years, P < 0.0001). An increase in severity of tricuspid valve regurgitation (TR) by ≥2 grades occurred in none of the LCP patients, and in 19% of the TVP patients (P = 0.017). Conclusion: There are no significant differences in procedural complications among patients receiving LCP versus TVP. The Micra group had lower rates of device-related revision/extraction compared to the TVP group. Patients with leadless pacemaker were less likely to develop endocarditis or worsening TR.

AB - Background: Leadless cardiac pacing (LCP) has emerged as a new modality for permanent pacing. We sought to describe comparative outcomes between LCP and transvenous pacemakers. Methods: Patients receiving LCP (Micra [Medtronic, Minneapolis, MN, USA] and Nanostim [St. Jude Medical/Abbott Laboratories, Chicago, IL, USA]) between 2014 and 2017 at the Mayo Clinic Heart Rhythm Enterprise practice (Rochester, MN, USA; Jacksonville, FL, USA; and Scottsdale, AZ, USA) were identified. We identified 1:1 age- and sex-matched controls receiving single-chamber transvenous ventricular pacemakers (TVP). Statistical analyses were performed with JMP 13.0.0 (SAS, Institute Cary, NC, USA). Results: Ninety patients underwent LCP implantation (73 Micra and 17 Nanostim) with a median follow-up duration of 62 (interquartile range 28-169) days. Both groups had 100% successful device implant rates. There were no differences in procedure-related major (0% vs 1%) or minor complications (8% vs 3%) in the LCP versus TVP groups (P > 0.05). Excluding Nanostim patients, there was a lower rate of device-related revision or extraction in the Micra versus TVP groups (0% vs 5%, P = 0.028). Device endocarditis was more common in the TVP group (0% vs 3%, P = 0.04). Estimated longevity was greater for the LCP group (median 12.0 vs 10.0 years, P < 0.0001). An increase in severity of tricuspid valve regurgitation (TR) by ≥2 grades occurred in none of the LCP patients, and in 19% of the TVP patients (P = 0.017). Conclusion: There are no significant differences in procedural complications among patients receiving LCP versus TVP. The Micra group had lower rates of device-related revision/extraction compared to the TVP group. Patients with leadless pacemaker were less likely to develop endocarditis or worsening TR.

KW - endocarditis

KW - leadless cardiac pacemaker

KW - transvenous pacemaker

KW - tricuspid regurgitation

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