Leadless pacemaker for patients following cardiac valve intervention
Leadless pacemaker for patients following cardiac valve intervention
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DOI：
10.1016/j.acvd.2020.05.012
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发表时间：
2020-12-01
影响因子：
3
通讯作者：
Willems, Rik
中科院分区：
文献类型：
--
作者：
Garweg, Christophe;Vandenberk, Bert;Willems, Rik
背景。永久性起搏是瓣膜介入术后常见的方法。在这一人群中使用传统起搏器被认为是感染事件的危险因素。因此，当瓣膜介入后需要永久性起搏时，无导联起搏系统可能是首选策略。目的：报道瓣膜介入术后植入无导联起搏系统患者的围手术期结果及随访情况。-纳入在尝试植入无导联起搏器（MicraTM, Medtronic, Minneapolis， MN， USA）时进行过瓣膜干预的患者，并与对照组（也植入Micra （TM）但未进行瓣膜干预的患者）进行比较。在总共170例Micra （TM）植入手术中，54例患者（31.8%）有瓣膜干预史：28例主动脉瓣置换术后；二尖瓣置换术后10例；单三尖瓣成形术后一例；多瓣膜手术后15例。患者中位年龄82.5岁（77.0 ~ 86.0岁），男性53.7%。既往行瓣膜置换术的患者动脉高血压（P = 0.014）和缺血性心脏病（P = 0.040）的发生率较高。瓣膜置换术后永久性起搏的主要适应症是高度房室传导阻滞（59.3%）和心房颤动合并心动过缓（27.8%）。所有患者（n = 170）均成功植入Micra (TM)，无任何与手术相关的主要并发症。在中位随访12个月期间，两组患者的电性能都很好且相似。此外，在12个月时，两组患者的左心室射血分数也有相似的下降，这与右心室起搏的百分比相关。无导联起搏器在瓣膜介入后安全有效，因此对于瓣膜介入后的患者是一种有效的起搏选择。(c) 2020 Elsevier Masson SAS。版权所有。
Background. - Permanent pacing is common after valve intervention. The presence of a conventional pacemaker in this population is recognized as a risk factor for infectious events. Therefore, a leadless pacing system could be the preferred strategy when permanent pacing is required after valve intervention.Aim. - To report periprocedural outcomes and follow-up of patients undergoing implantation of a leadless pacing system after valve intervention.Methods. - Patients with previous valve intervention at the time of attempted implantation of a leadless pacemaker (MicraTM, Medtronic, Minneapolis, MN, USA) were included, and were compared with a control group (patients also implanted with Micra (TM) without valve intervention).Results. - Among a total of 170 Micra (TM) implantation procedures, 54 patients (31.8%) had a history of valve intervention: 28 after aortic valve replacement; 10 after mitral valve replacement; one after single tricuspid valvuloplasty; and 15 after multiple valve surgery. Median age of the patients was 82.5 (77.0-86.0) years and 53.7% were male. Patients with previous valve intervention had a higher incidence of arterial hypertension (P = 0.014) and ischaemic heart disease (P = 0.040). The primary indications for permanent pacing after valve intervention were high-degree atrioventricular block (59.3%) and atrial fibrillation with bradycardia (27.8%). Micra (TM) was successfully implanted in all patients (n = 170) without any procedure-related major complications. During a median follow-up of 12 months, electrical performance was excellent and similar in both groups. Also, a similar reduction in left ventricular ejection fraction was observed at 12 months in both groups, which was correlated with the percentage of right ventricular pacing.Conclusion. - A leadless pacemaker is safe and efficient after valve intervention, and therefore represents an effective pacing option in patients after valve intervention. (c) 2020 Elsevier Masson SAS. All rights reserved.