Long-Term Safety and Efficacy of Intraoperative Leadless Pacemaker Implantation During Valve Surgery

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Clinical electrophysiology Pub Date : 2024-10-01 DOI:10.1016/j.jacep.2024.06.018

Connor P. Oates MD , Karel T.N. Breeman MD , Marc A. Miller MD , Percy Boateng MD , Aarti Patil MD , Daniel R. Musikantow MD , Elbert Williams MD , Ismail El-Hamamsy MD , Morgan L. Montgomery MD , Benjamin S. Salter MD , Chartaroon Rimsukcharoenchai MD , Dimosthenis Pandis MD , Menachem M. Weiner MD , Srinivas R. Dukkipati MD , Anelechi Anyanwu MD , Vivek Y. Reddy MD , David H. Adams MD , Ahmed M. El-Eshmawi MD

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Abstract

Background

Intraoperative implantation of leadless cardiac pacemakers (LCPs) under direct visualization during cardiac surgery is a novel strategy to provide pacing to patients with an elevated risk of postoperative conduction disorders or with a preexisting pacing indication undergoing valve surgery.

Objectives

This study sought to evaluate the long-term safety and efficacy of intraoperative LCP implantation in 100 consecutive patients.

Methods

Retrospective single-center cohort study of consecutive patients (n = 100) who underwent intraoperative LCP implantation during valve surgery. Safety and efficacy were assessed at implantation and follow-up visits.

Results

A total of 100 patients (age 68 ± 13 years, 47% female) underwent intraoperative LCP implantation. The surgery involved the tricuspid valve in 99 patients (99%), including tricuspid valve repair in 59 (59%) and tricuspid valve replacement in 40 (40%). Most of the patients (78%) underwent multivalve surgery. The indication for LCP implantation was elevated risk of postoperative atrioventricular block in 54% and preexisting bradyarrhythmias in 46%. LCP implantation was successful in all patients. During a median of 10.6 months (IQR: 2.0-22.7 months) of follow-up, no device-related complications occurred. At 12-month follow-up, the pacing thresholds were acceptable (≤2.0 V at 0.24 milliseconds) in 95% of patients.

Conclusions

Intraoperative LCP implantation under direct visualization is a safe strategy to provide permanent pacing in patients undergoing valve surgery, with a postoperative electrical performance comparable to percutaneously placed LCPs.

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瓣膜手术期间术中植入无引线起搏器的长期安全性和有效性

背景：在心脏手术直视下术中植入无导联心脏起搏器（LCP）是一种新策略，可为术后传导障碍风险较高或已有起搏指征的瓣膜手术患者提供起搏：本研究旨在评估 100 例连续患者术中植入 LCP 的长期安全性和有效性：方法：对在瓣膜手术中接受术中 LCP 植入的连续患者（n = 100）进行回顾性单中心队列研究。结果：共有 100 名患者（年龄 68 岁）接受了瓣膜手术术中 LCP 植入：共有 100 名患者（年龄为 68 ± 13 岁，47% 为女性）接受了术中 LCP 植入术。99名患者（99%）的手术涉及三尖瓣，包括59名患者（59%）的三尖瓣修复术和40名患者（40%）的三尖瓣置换术。大多数患者（78%）接受了多瓣膜手术。LCP 植入术的适应症是术后房室传导阻滞风险升高（54%）和原有缓慢性心律失常（46%）。所有患者都成功植入了 LCP。在中位 10.6 个月（IQR：2.0-22.7 个月）的随访期间，没有发生与设备相关的并发症。随访12个月时，95%的患者起搏阈值合格（0.24毫秒时≤2.0 V）：结论：在直视下进行术中 LCP 植入是一种为接受瓣膜手术的患者提供永久起搏的安全策略，术后的电气性能与经皮放置的 LCP 不相上下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.