Leadless pacing with Micra TPS: A comparison between right ventricular outflow tract, mid-septal, and apical implant sites.
Action Potentials
Adult
Aged
Aged, 80 and over
Arrhythmias, Cardiac
/ diagnosis
Cardiac Catheterization
/ adverse effects
Cardiac Catheters
Cardiac Pacing, Artificial
Electrocardiography
Equipment Design
Female
Heart Rate
Humans
Male
Middle Aged
Pacemaker, Artificial
Time Factors
Treatment Outcome
Ventricular Function, Right
Micra TPS
QRS duration
leadless pacing
right ventriculography
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
22
04
2019
revised:
12
07
2019
accepted:
14
07
2019
pubmed:
25
7
2019
medline:
22
9
2020
entrez:
25
7
2019
Statut:
ppublish
Résumé
With its steerable transcatheter delivery system, the Micra can be deployed in nonapical positions within the right ventricle, potentially allowing reduction of the paced QRS width. We sought to evaluate the safety and long-term performance of the right ventricular outflow tract (RVOT) pacing using the Micra transcatheter pacing system (TPS). We also compared the paced QRS between RVOT, mid-septal, and apical implant positions. All patients who underwent a Micra TPS implantation at the University Hospitals of Leuven were enrolled in this observational study. Right ventricular (RV) position of the device was assessed on per-procedural ventriculography. Paced QRS was analyzed and follow-up completed at 1 month and then every 6 months. Among the 133 patients included (mean follow-up: 13 ± 11 months), 45 were implanted in the RVOT, 58 midseptally, and 30 at the apex. All implant procedures were successful and no pericardial effusion was encountered within the 30 days post-implant. Two major complications were reported with devices implanted at the apex. Pacing impedance was significantly higher in the RVOT compared to the mid-septal and apical position (P < .001). Pacing threshold and R-wave amplitude did not differ over time in either position. The median narrowest paced QRS duration was observed in the RVOT (142 ms) compared to mid-septal (159 ms; P < .001), and apical position (181 ms; P < .001). Implantation of the Micra TPS in the RVOT is safe and feasible. Electrical performance over time was comparable to mid-septal and apical positions. The narrowest paced QRS complexes is achieved with RVOT pacing.
Sections du résumé
BACKGROUND
With its steerable transcatheter delivery system, the Micra can be deployed in nonapical positions within the right ventricle, potentially allowing reduction of the paced QRS width. We sought to evaluate the safety and long-term performance of the right ventricular outflow tract (RVOT) pacing using the Micra transcatheter pacing system (TPS). We also compared the paced QRS between RVOT, mid-septal, and apical implant positions.
METHODS
All patients who underwent a Micra TPS implantation at the University Hospitals of Leuven were enrolled in this observational study. Right ventricular (RV) position of the device was assessed on per-procedural ventriculography. Paced QRS was analyzed and follow-up completed at 1 month and then every 6 months.
RESULTS
Among the 133 patients included (mean follow-up: 13 ± 11 months), 45 were implanted in the RVOT, 58 midseptally, and 30 at the apex. All implant procedures were successful and no pericardial effusion was encountered within the 30 days post-implant. Two major complications were reported with devices implanted at the apex. Pacing impedance was significantly higher in the RVOT compared to the mid-septal and apical position (P < .001). Pacing threshold and R-wave amplitude did not differ over time in either position. The median narrowest paced QRS duration was observed in the RVOT (142 ms) compared to mid-septal (159 ms; P < .001), and apical position (181 ms; P < .001).
CONCLUSION
Implantation of the Micra TPS in the RVOT is safe and feasible. Electrical performance over time was comparable to mid-septal and apical positions. The narrowest paced QRS complexes is achieved with RVOT pacing.
Types de publication
Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2002-2011Informations de copyright
© 2019 Wiley Periodicals, Inc.