The Large Right Heart Is Associated with the Prolongation of the Procedure Time of Leadless Pacemaker Implantation

Background and objectives: Leadless pacemakers are less invasive but are as effective as conventional pacemakers and are increasingly implanted in elderly patients. However, the implantation procedure is sometimes challenging in patients with abnormal anatomy, particularly those with an enlarged right heart. We aimed to determine the right heart parameters that were associated with longer procedure times for leadless pacemaker implantation. Materials and Methods: Among 19 consecutive patients in whom Micra leadless pacemakers (Micra TPS, Medtronic, Minneapolis, MN) were implanted, the diameter and area of both the right atrium and right ventricle were measured by transthoracic echocardiography before the procedure. The right heart parameters that were associated with a procedure time > 60 min were investigated. Results: In the 19 patients (median 81 years old, 10 male) who underwent implantation of the Micra system, 6 (32%) required a procedure time > 60 min. Among the baseline right heart echocardiographic parameters, right atrial diameter and area were significantly associated with a procedure time > 60 min (odds ratio 11.3, 95% confidence interval 1.09–1.17, p = 0.042; and odds ratio 1.57, 95% confidence interval 1.05–2.34, p = 0.029, respectively) at a cutoff of 4.0 cm and 17.0 cm2, respectively. Conclusions: Patients with an enlarged right atrium may not be good candidates for leadless pacemakers given the longer procedure time, and conventional pacemakers should perhaps be recommended as an alternative.

Modulation of Heart Contractility

Patients with heart failure (HF) are being benefi ted by electric therapy through conventional pacemakers when associated to bradycardia and cardiac resynchronization therapy or with low ejection fraction and presence of QRS longer than 150 ms, mainly in the presence of left branch block. Other groups of patients with HF present limitations regarding electrotherapy. However, an old concept has gained space in the treatment of patients who are outside the national and international guidelines for electrotherapy in HF: the modulation of heart contractility. This article has the purpose of presenting a review of already produced scientifi c evidence regarding this new modality for HF treatment

Leadless pacemaker – potential indications for use based on real life cases

Implantation of leadless pacemakers is associated with significantly fewer complications when compared to conventional pacemakers due to elimination of transvenous leads, which are among the weakest components of the pacing system. There are patients in whom implantation of a conventional transvenous pacemaker is very troublesome and problematic or associated with a higher risk of complications, including infectious, as a result of a very limited venous access or use of central veins for other purposes (for example haemodialysis or administration of drugs). We present two real life clinical cases as examples of potential indications for use of leadless pacemakers in everyday practice.