Transcatheter leadless cardiac pacing: The new alternative solution

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Limited data exists on leadless pacemaker (LPM) feasibility and safety in patients with challenging venous anatomy or contraindications to conventional pacemakers (PMs).
• Fragile patient populations often present unique challenges for device implantation.

Purpose of the Study:

• To evaluate the safety and feasibility of LPM implantation in patients with limited venous access or contraindications to conventional PMs.
• To report mid-term outcomes of LPMs in a high-risk cohort.

Main Methods:

• Prospective observational study including 14 patients between May 2015 and July 2016.
• Patients had indications including atrioventricular (AV) block, bradyarrhythmia, or uncontrolled atrial fibrillation (AFib) requiring AV-node ablation.
• Exclusion criteria included normal venous access pathways and absence of contraindications.

Main Results:

• All 14 procedures were successful with stable electrical parameters.
• No direct pacemaker-related adverse events were reported, except for one case of ventricular fibrillation post-implantation.
• Patients had complex comorbidities, including occluded venous pathways, end-stage renal disease, and previous infections.

Conclusions:

• Leadless pacemakers demonstrated stable performance and reassuring safety in a fragile patient population.
• The Micra LPM is a suitable alternative to epicardial surgical approaches in this high-risk group.