Leadless pacemaker implantation following tricuspid interventions: multicenter collaboration of feasibility and safety

Abstract

BackgroundPermanent pacing is often required following valve intervention (either surgical or percutaneous); however, tricuspid interventions pose specific challenges to conventional pacing. Therefore, leadless pacemaker (LP) implantation may be the preferred strategy when permanent pacing is required after tricuspid valve intervention.PurposeTo report periprocedural outcomes and follow-up of patients undergoing implantation of a LP system following tricuspid valve interventions.MethodsPatients with previous tricuspid valve intervention at the time of attempted implantation of a LP (MicraTM, Medtronic, Minneapolis, MN, USA) were included.ResultsBetween 2019 and 2022, 40 patients underwent LP implantations following tricuspid interventions in 5 large tertiary centers. The mean age was 68.9 +/- 13.7 years, and 48% patients were male. The indication for pacing was as following: AVB in 27 (68%) patients, AF with slow ventricular response in 10 (25%) patients, and refractory rapid atrial fibrillation (AF) referred to AV junction ablation in 3 (7%) patients. Most of the patients received Micra VR (78%). The procedure was successful in all patients. The mean procedural time is 58 +/- 32 min, and the median fluoroscopy time is 7.5 min. Electrical parameters were within normal range (threshold: 1.35 +/- 1.2 V@0.24 ms, impedance: 772 +/- 245 Ohm, R-wave: 6.9 +/- 5.4 mV). No acute complications were observed. During a mean follow-up of 10 months, electrical parameters remained stable, and 4 deaths were occurred (not related to the procedure).ConclusionA LP is a safe and efficient option following tricuspid valve interventions.