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 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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