Leadless Pacemaker Implantation in Patients With a Prior Conventional Pacing System

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2024-04-01 DOI:10.1016/j.cjco.2023.12.008

Julius Jelisejevas MD , François Regoli MD , Daniel Hofer MD , Giulio Conte MD , Tardu Oezkartal MD , Ardan M. Saguner MD , Maria Luce Caputo MD , Lorenzo Grazioli MD , Jan Steffel MD , Angelo Auricchio MD , Alexander Breitenstein MD

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Abstract

Background

Leadless pacing has been established as an alternative approach to transvenous devices for selected patients. Often, leadless pacemaker (LP) implantation is a de novo procedure, but in an increasing number of patients, an LP is used after previous implantation of a conventional pacing system (CPS).

Methods

A retrospective analysis was conducted of the efficacy and safety of LP implantation in the context of a previously implanted CPS, from 2 large Swiss centres.

Results

A total of 257 consecutive patients undergoing LP implantation were included. They were divided into 2 groups: group 1 consisted of 233 patients who did not have a previous CPS, and group 2 consisted of 24 patients with an in situ CPS. In group 2, a total of 20 patients (83%) required transvenous lead extraction due to infection, malfunction, or other reasons. In 3 patients with device-related infection, lead extraction and LP implantation was performed as a single procedure, whereas in the remaining 11 cases, a time window occurred between the 2 procedures (median: 11.5 days; range: 2-186 days). Electrical device parameters at implantation and during follow-up did not differ between the 2 groups (mean: 12.5 ± 9.3 months). Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 instances of femoral bleeding, and 1 instance of intra-abdominal bleeding) in the entire cohort within a 30-day period. No complications occurred in the group with a previous device. No infections were registered, even when complete extraction of an infected CPS was performed prior to LP implantation.

Conclusions

Implantation of an LP in patients with a prior CPS (with or without extraction of the previous system) was effective and safe in our population of patients.

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为曾使用过传统起搏系统的患者植入无导线起搏器

背景无导线起搏已被确定为经静脉装置的替代方法，适用于特定患者。通常情况下，无导线起搏器（LP）植入术是一种全新的手术，但越来越多的患者在之前植入传统起搏系统（CPS）后使用 LP。方法对瑞士两家大型中心在之前植入 CPS 的情况下植入 LP 的有效性和安全性进行了回顾性分析。他们被分为两组：第一组包括 233 名既往未植入 CPS 的患者，第二组包括 24 名原位植入 CPS 的患者。在第 2 组中，共有 20 名患者（83%）因感染、故障或其他原因需要拔除经静脉导联。在 3 例因装置感染的患者中，导联拔除和 LP 植入是作为单个手术进行的，而在其余 11 例患者中，2 个手术之间存在时间间隔（中位数：11.5 天；范围：2-186 天）。两组患者在植入时和随访期间的电子装置参数没有差异（平均：12.5 ± 9.3 个月）。整个组群在 30 天内出现了 8 例主要的围手术期并发症（3.1%）（4 例心包积液、3 例股动脉出血和 1 例腹腔内出血）。曾使用过设备的组员未出现并发症。结论在我们的患者群体中，为曾使用过 CPS 的患者植入 LP（无论是否拔除先前的系统）既有效又安全。

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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