scholarly journals A new leadless pacemaker with atrioventricular synchronous pacing replacing a still working VVI leadless pacemaker: a case report

2021 ◽  
Author(s):  
Massimo Moltrasio ◽  
Rita Sicuso ◽  
Fabrizio Tundo ◽  
Claudio Tondo
Keyword(s):  
Pacemaker Implantation ◽  
Good Alternative ◽  
Functional Class ◽  
Ventricular Pacing ◽  
Short Term ◽  
Jude Medical ◽  
Leadless Pacemaker ◽  
Atrial Sensing ◽  
Asynchronous Pacing

Abstract Background A new intracardiac leadless pacemaker (ILP) has been developed to ensure atrioventricular synchrony during ventricular pacing. Recent studies have shown feasibility and safety of accelerometer-based atrial sensing and an improvement in atrioventricular synchrony among patients with atrioventricular block implanted with the Micra AV ILP (Medtronic Inc, Minneapolis, Minnesota, US). However, no data exists about the benefits of a VDD ILP in patients wearing a still working VVI Nanostim ILP (St Jude Medical, St Paul, Minnesota, US). We describe the feasibility of the procedure and the absence of device-related adverse events in the short-term follow-up. Case summary We present the case of a 72-year-old man implanted with a VVI ILP (Nanostim, St Jude Medical, St Paul, MN) on May 2014, who has developed symptomatic high percentage of VVI asynchronous pacing and was treated with an upgrade to synchronous AV PM ILP—Micra AV (Medtronic Inc, Minneapolis, Minnesota, US), which has improved symptoms and functional class. Discussion ILPs represent the best current option for patients requiring pacemaker implantation who are at high risk of infection and bleeding. Our case shows that the new AV synchronous ILP is a good alternative to VVI ILP in patients with sinus rhythm and a strong need for ventricular pacing.

scholarly journals Outcomes of leadless pacemaker implantation in patients with mechanical heart valves

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Loughlin ◽  
M Pachon ◽  
J.L Martinez-Sande ◽  
J.L Ibanez ◽  
T Bastante ◽  
...  
Keyword(s):  
Heart Valves ◽  
Pacemaker Implantation ◽  
Major Complication ◽  
Mechanical Heart Valves ◽  
Electrical Performance ◽  
Funding Sources ◽  
Leadless Pacemaker ◽  
Attractive Option ◽  
Procedural Outcomes

Abstract Introduction Device-related infections constitute a major complication of transvenous pacemaker implantation. Mechanical heart valves (MHV) increase the risk of infective endocarditis (IE) and pacemaker infection, worsening their outcomes.Leadless pacemakers (LP) have been associated with low infection rates and thus pose an attractive option in MHV patients requiring permanent pacing. Methods and results This is a multicenter, observational, retrospective study including all consecutive patients implanted with an LP at 5 tertiary referral centers between June 2015 and January 2020.Procedural outcomes, complications, performance during follow-up and episodes of bacteremia and IE were recorded and compared between patients with and without a MHV (MHV and non-MHV groups).Four hundred fifty-nine patients were included (74 in the MHV group, 16.1%, and 385 in the non-MHV group, 83.9%).Implantation success, procedural outcomes and acute electrical performance were comparable between groups.Vascular complications and cardiac perforation occurred in 2.7 vs. 2.3% (p=1) and 0% vs. 0.8% (p=1) in the MHV group and non-MHV group, respectively.During a median post-implant follow-up of 308 days for the MHV group and 416 days for non-MHV patients (p=0.029), one case of IE was reported in the MHV group and 2 in the non-MHV group. All three occurred in patients with abandoned transvenous leads. Conclusion LP implantation is feasible and safe in patients with MHV, with procedural outcomes and electrical performance comparable to the general LP population. Device-related infections, including IE, are rare in patients receiving an LP, including those with an MHV. LP implantation should be considered in MHV patients with an indication for pacing. Funding Acknowledgement Type of funding sources: None. Procedural outcomes and complicationsBaseline and follow-up parameters

scholarly journals Conduction disturbances after TAVR: rates of pacemaker implantation, burden of ventricular pacing and prognostic significance

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Bricoli ◽  
G Benatti ◽  
L Vignali ◽  
I Tadonio ◽  
MF Notarangelo ◽  
...  
Keyword(s):  
Prognostic Significance ◽  
Pacemaker Implantation ◽  
Av Block ◽  
Ventricular Pacing ◽  
Conduction Disturbances ◽  
Long Term Follow Up ◽  
Rv Pacing ◽  
Complete Av Block

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The occurrence of conduction disturbances remains frequent after TAVR. However, the effect of PM on mortality is controversial and many patients may recover spontaneous AV conduction during follow-up.  PURPOSE To evaluate the incidence of PM implantation after TAVR, PM dependency and  burden of ventricular pacing during follow-up and their influence on mortality.  METHODS AND RESULTS We performed a retrospective analysis of all consecutive 293 patients who underwent TAVR from 2015 to 2019 at our hospital, regional hub for this procedure. Patients were classified into 3 groups: patients without PM (no-PM), patients with a PM implanted prior to TAVR (pre-PM) and patients requiring a PM following TAVR (post-PM) and their clinical and procedural characteristics are listed in Table 1.  The rate of PM implantation after TAVR was 20,8%, at a median of 3.6 days after the procedure. The most common indication was complete AV block. A VVIR pacemaker was implanted in 28 patients, a DDD/DDDR PM in 27 patients and 2 patients received a CRT device. Among post-PPM patients, only 16% were PM-dependent at 2-month and 1-year follow-up. All of them received a PM for complete AV block (AVB). At 1-year follow-up, RV pacing burden was 60% among AVB patients and 23% in patients with a PM implanted for other reasons. PM implantation after TAVR was not associated with a mortality difference at 30-day, 1-year and long-term follow-up. Pre-PPM patients showed a higher mortality rate at long-term follow-up although not statistically significant. CONCLUSIONS Our data suggest that a single chamber device should be preferred in patients implanted for reasons other than complete AVB; in patients with AVB, the use of dual chamber device with an algorithm to minimize RV pacing should be the most suitable choice. Overall (293)No PPM (216)Pre-PPM (19)Post-PPM (57)p-valueAge, median(IQR)82(80-86)82(80-86)82(79-87)82(80-86)0,53Female, n(%)160(55)129(59)6(32)25(44)0,40NYHA III-IV, n(%)191(65)147(68)15(79)29(51)0,06Logistic Euroscore, mean (IQR)7,53(3,5-8,3)7(3,5-8)9,83(3,6-12)6(3,5-7,4)0,51Right bundle-branch block, n(%)21(7)13(6)na8(14)0,04AVA, mean ± SD0,69 ± 0,190,7 ± 0,190,7 ± 0,160,66 ± 0,180,23Self-expandable valve, n(%)181(62)123(57)12(63)46(81)0,001Balloon-expandable valve, n(%)102(35)86(40)7(37)8(14)0,0003Implant depth, mean ± SD6,87 ± 2,96,32 ± 2,65,71 ± 39,12 ± 30,0001Abstract Figure. Kaplan-Meier survival curve

scholarly journals A case report of unusually long episodes of asystole in a severe COVID-19 patient treated with a leadless pacemaker

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6
Author(s):  
Ivan Cakulev ◽  
Jayakumar Sahadevan ◽  
Mohammed Najeeb Osman
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Pacemaker Implantation ◽  
Av Block ◽  
Leadless Pacemaker ◽  
Case Summary ◽  
Cardiac Manifestations

Abstract Background Experience has been emerging about cardiac manifestations of COVID-19-positive patients. The full cardiac spectrum is still unknown, and management of these patients is challenging. Case summary We report a COVID-19 patient who developed unusually long asystolic pauses associated with atriventricular block (AV) block and atrial fibrillation who underwent leadless pacemaker implantation. Discussion Asystole may be a manifestation of COVID-19 infection. A leadless pacemaker is a secure remedy, with limited requirements for follow-up, close interactions, and number of procedures in a COVID-19 patient.

scholarly journals B-PO03-055 CONCOMITANT LEADLESS PACEMAKER IMPLANTATION AND LEAD EXTRACTION DURING AN ACTIVE INFECTION: A LONG-TERM FOLLOW UP

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S210-S211
Author(s):  
Evan Choi ◽  
David Chang ◽  
James K. Gabriels ◽  
Beom Soo Kim ◽  
Eric Pagan ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Lead Extraction ◽  
Active Infection ◽  
Leadless Pacemaker ◽  
Long Term Follow Up

scholarly journals The use of carbon fiber cages in anterior cervical interbody fusion

2002 ◽  
Vol 12 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Khalil Salame ◽  
Georges E. R. Ouaknine ◽  
Nissim Razon ◽  
Semion Rochkind
Keyword(s):  
Carbon Fiber ◽  
Interbody Fusion ◽  
Good Alternative ◽  
Cervical Lordosis ◽  
Short Term ◽  
Alternative Material ◽  
Solid Fusion ◽  
Bone Fragments ◽  
The Mean

Object Cage devices were introduced in spinal fusion to overcome the shortcomings of autograft, allograft, and biocompatible implants. The aim of this study was to assess the short-term results of anterior cervical discectomy and fusion (ACDF) in which an interbody carbon fiber cage (CFC) and local osteophyte–derived bone graft were implanted. Methods A retrospective review was conducted of 100 consecutive patients treated by ACDF in which a CFC was packed with bone fragments obtained from osteophytes at the surgical site. Plain radiographs with dynamic lateral views obtained 1 year postoperatively were used to assess bone fusion, alignment of the cervical spine, and stability. Dynamic radiographs were also obtained at last follow up to determine whether loss of cervical alignment or collapse at the fused disc had occurred. The mean follow-up period was 25 months. In all cases the cervical lordosis was maintained or corrected to different extents and disc height was restored. Solid fusion was achieved in 98% of the cases. There were no cage-related complications and no cases of cage failure. Conclusions The authors conclude that application of the CFC for ACDF is safe, effective, and technically feasible. Osteophytes resected during surgery may be a good alternative material for bone grafting in cage-assisted cervical interbody fusion.

scholarly journals 1226 Prognostic impact of concomitant cardiac amyloidosis in aortic stenosis patients referred for transcatheter aortic valve implantation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Ferreira ◽  
S Aguiar Rosa ◽  
I Rodrigues ◽  
L Moura Branco ◽  
A Galrinho ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Functional Class ◽  
Transcatheter Aortic Valve ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background The prevalence of cardiac amyloidosis (CA) and aortic stenosis (AS) both increase with age. Transcatheter aortic valve implantation (TAVI) expands the number of patients (P) eligible for treatment of AS, emphasizing the need to understand the prevalence of CA in AS and its prognostic associations. Echocardiography with speckle tracking has emerged as a useful method to enhance the clinical suspicion and to provide prognostic information. Purpose To estimate the prevalence of CA in P with severe AS referred for TAVI and to evaluate the impact of concomitant CA in prognosis. Methods 94 consecutive AS P who underwent TAVI with maximum left ventricular wall thickness (LVWT)>12 mm were retrospectively identified. Clinical data, pre TAVI echocardiographic parameters and follow up (FU) data regarding all-cause mortality and MACE (including all-cause mortality, admission for heart failure, pacemaker implantation and stroke) were analysed. We registered apical sparing pattern in bull’s eye plots (ASPB), calculated relative apical longitudinal strain formula (RALS) [average apical LS/(average basal LS + mid-LS)] and ejection fraction/global longitudinal strain (EF/GLS) ratio. Results Mean age was 82.2 ± 5.8 years (Y), with 43 men (45.7%). 27.7% were in NYHA functional class II, 64.9% in functional class III and 7.4% in functional class IV. Median EF was 57 ± 15% and 26.6% presented EF < 50%. Suspected CA evaluated by ASPB was found in 39 P (41.5%) and RALS > 1 was identified in 22 P (23.4%). An EF/GLS ratio > 4.1 was obtained in 53 P (56.4%). Over a median follow-up of 13.4 ± 25.8 months, 28 deaths (29.8%) and 31 MACEs (33.0%) occurred. The presence of ASPB was associated with increased all-cause mortality (33.3% vs. 5.6%, p = 0.002), new bundle branch block and indication for pacemaker implantation (46.2% vs 37.0%, p = 0.05) and MACE (48.7% vs 22.2%, p = 0.01). All-cause mortality was also higher in P with RALS (31.8% vs. 12.5%, p = 0.04). P with GLS>-14.8% and ASPB had significantly worse prognosis regarding all-cause mortality (p = 0.003) and MACE (p = 0.007). Kaplan–Meier survival analysis showed that survival was significantly worse for P with ASPB (log-rank 0.002). With multivariate Cox regression analysis, ASPB was independently associated with all-cause mortality (HR = 4.49, p = 0.039). Conclusions Suspected CA appears prevalent among patients with AS and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation. Abstract 1226 Figure. Kaplan–Meier curves and ASPB

scholarly journals Leadless pacemaker implant with concomitant atrioventricular node ablation: a single center study with longterm followup

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
JL Martinez Sande ◽  
J Garcia-Seara ◽  
L Gonzalez-Melchor ◽  
M Rodriguez-Manero ◽  
A Torrelles-Fortuny ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Vena Cava ◽  
Atrioventricular Node ◽  
Conventional Technique ◽  
Electrical Performance ◽  
Single Center ◽  
Av Node ◽  
Leadless Pacemaker ◽  
Long Run

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Feasibility of concomitant leadless-pacemaker(LP) implantation plus atrioventricular node ablation(AVNA) is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming . Objective We aim to report 1) feasibility of concomitant AVNA after a LP implantation and 2) long-term outcomes.  Methods Single center, prospective and observational study of 243 consecutive patients with an indication for single-chamber pacemaker placement. The implantation procedure was carried out using a femoral approach and conventional technique. Successful implantation was accomplished in 242/243 patients referred for leadless implantation. In one patient, a complete obstruction of the inferior vena cava was documented, and a conventional unicameral pacemaker was implanted. Results 33 out of  242 patients underwent immediate AV ablation. Mean age was 75.2 ± 8.3 years. Were predominantly females: 25(75.7%) and indication was fast conduction atrial fibrillation(n = 25), atypical flutter or atrial tachycardia (n = 8). Mean acute "R wave" was 11.3mV, threshold of 0.55Vx0.24ms and impedance of 833Ω. Uneventful AV node ablation was performed in all of them immediately after LP implantation. Additional mean fluoroscopic time was 3.0 minutes. There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of  19.9± 12 months, all patients remained alive without notable event, and electrical parameters remained unchanged.(Figure 1) Conclusions Conconmitant AVN ablation after LP implantation seems feasible without remarkable complications in the long run.  In our  experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation. There were no device macrodislodgements or unexpected device malfunctions in the follow-up period. Abstract Figure. Electrical performance

Abstract 14856: Leadless Pacemaker Implantation in Patients With Paroxysmal Complete Atrioventricular Block

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ivan mendoza ◽  
Jorge Penalver ◽  
Ninoska N Aranguibel ◽  
Chamorro Jose ◽  
Juan P zambrano ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Complication Rates ◽  
Av Block ◽  
Test Analysis ◽  
Leadless Pacemaker ◽  
Pacemaker Syndrome ◽  
Ventricular Response ◽  
Feasible Alternative ◽  
Complete Av Block

Introduction: Transcatheter pacing systems have recently emerged as a safe and effective alternative in treating patients who require right ventricular pacing therapy. Traditionally, patients with atrial fibrillation with slow ventricular response had been benefit from this therapy. More recent, patients with symptomatic paroxysmal complete AV block had been receiving these devices. At this moment there is no data available about the feasibility , safety or outcomes of leadless pacemaker in this subgroup of patients Objective: The aim of this study was to assess the feasibility safety and 1 year follow up of the transcatheter leadless pacemaker device in patients with paroxysmal complete AV block . Methods: One hundred and ten (110 ) consecutive patients who underwent implantation of a Micra transcatheter leadless pacemaker (LPM)and have been follow up for at least a year were evaluated . Forty one (41) of these patients had the device implanted after experiencing symptomatic paroxysmal complete AV block. A t-test analysis was used to compare patient demographics, total procedure times, complication rates and recaptures necessary during the procedure. Results: All the patients with symptomatic paroxysmal complete AV block were implanted successfully with the leadless pacemaker system ( LPN ) . None of the patients suffered complications during the procedures. Fifty three percent ( 53%) were female , mean age of 77 , mean procedure time was 21.1 min. The mean number of recaptures required were 0.48 . None of the patient experienced pacemaker syndrome or progress to complete AV block after 1 year of follow up Conclusion: Leadless pacemaker implantation appears to be a safe and feasible alternative for subjects with symptomatic paroxysmal complete AV block . Further studies are required in these subgroup of patients

scholarly journals 073_16796-J1 Micra Leadless Pacemaker. Implantation and Mid-Term Follow-Up Results

2017 ◽  
Vol 3 (10) ◽  
pp. S38-S39
Author(s):  
J.L. Martínez-Sande ◽  
J. García-Seara ◽  
L. González-Melchor ◽  
M. Rodríguez-Mañero ◽  
X.A. Fernández-López ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
Leadless Pacemaker
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