Determinants of the difficulty of leadless pacemaker implantation
Determinants of the difficulty of leadless pacemaker implantation
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DOI：
10.1111/pace.13933
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发表时间：
2020-05-21
影响因子：
1.8
通讯作者：
Willems, Rik
中科院分区：
文献类型：
--
作者：
Garweg, Christophe;Vandenberk, Bert;Willems, Rik
Micra经导管起搏系统通过可操纵的经导管输送系统经股静脉直接植入右心室（RV）。本研究旨在确定无导联心脏起搏器植入手术困难的决定因素，包括操作人员、患者和右心室解剖特征。方法对2015年7月至2018年12月在我中心接受Micra种植的所有患者进行分析。通过植入期间获得的右心室血管造影，表征右心室几何形状，包括收缩和舒张容积和射血分数。可见鼻中隔边缘小梁。结果共纳入126例患者，平均年龄79±11岁，男性居多，占77%。平均Micra RV植入手术时间为24 +/- 23分钟，设备部署1.7 +/- 1.3次。前30次种植后，种植时间无明显变化。11例患者在右心室有明显的鼻中隔边缘小梁。单因素分析显示，手术时间与鼻中隔边缘小梁的出现呈正相关（P < 0.001）或心衰发作（P = 0.02），与手术次数负相关（P < 0.001）。在多变量分析后，只有鼻中隔边缘小梁突出部分的存在（P < .001）和手术次数（P < .001）与植入手术时间有关。根据我们的经验，Micra无铅起搏器的植入时间取决于鼻中隔小梁的存在和操作人员的经验。
Background The Micra Transcatheter Pacing System is implanted directly in the right ventricle (RV) through the femoral vein using a steerable transcatheter delivery system. The present study was done to identify determinants of difficult leadless pacemaker implant procedures including operator, patient, and RV anatomical characteristics.Methods All patients who underwent a Micra implant from July 2015 to December 2018 at our center were analyzed. From an RV angiogram acquired during implantation, RV geometry including systolic and diastolic volumes and ejection fraction was characterized. The presence of septomarginal trabeculation was noted.Results One hundred twenty-six patients (mean age: 79 +/- 11 years old, mostly male: 77%) were enrolled. Mean Micra RV implant procedure time was 24 +/- 23 min, with 1.7 +/- 1.3 deployments of the device. No significant change in implant procedure time was observed after the first 30 implants. Eleven patients had a prominent septal component of the septomarginal trabeculation in the RV. Univariate analysis showed that the procedure time was positively correlated with the presence of a prominent septal component of the septomarginal trabeculation (P < .001) or an episode of heart failure (P = .02) and negatively correlated with the number of procedures performed by the operator (P < .001). After multivariable analysis, only the presence of a prominent septal component of the septomarginal trabeculation (P < .001) and the number of procedures performed by the operator (P < .001) were associated with the implant procedure time.Conclusions In our experience, implant procedure time of a Micra leadless pacemaker depended on the presence of a prominent septal component of the septomarginal trabeculation and operator experience.