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. 2019 Apr;30(4):569-574.
doi: 10.1111/jce.13851. Epub 2019 Jan 28.

Leadless pacemaker implant in patients with pre-existing infections: Results from the Micra postapproval registry

Mikhael F El-Chami  1 , Jens Brock Johansen  2 , Amir Zaidi  3 , Svein Faerestrand  4 , Dwight Reynolds  5 , Javier Garcia-Seara  6 , Jacques Mansourati  7 , Jean-Luc Pasquie  8 , Hugh Thomas McElderry  9 , Paul R Roberts  10 , Kyoko Soejima  11 , Kurt Stromberg  12 , Jonathan P Piccini  13
Affiliations

Leadless pacemaker implant in patients with pre-existing infections: Results from the Micra postapproval registry

Mikhael F El-Chami et al. J Cardiovasc Electrophysiol. 2019 Apr.

Abstract

Introduction: Leadless pacemakers may provide a safe and attractive pacing option to patients with cardiac implantable electronic device (CIED) infection. We describe the characteristics and outcomes of patients with a recent CIED infection undergoing Micra implant attempt.

Methods and results: Patients with prior CIED infection and device explant with Micra implant within 30 days, were identified from the Micra post approval registry. Procedure characteristics and outcomes were summarized. A total of 105 patients with prior CIED infection underwent Micra implant attempt ≤30 days from prior system explant (84 [80%] pacemakers and 13 [12%] ICD/CRT-D). All system components were explanted in 93% of patients and explant occurred a median of 6 days before Micra implant, with 37% occurring on the day of Micra implant. Micra was successfully implanted in 99% patients, mean follow-up duration was 8.5 ± 7.1 months (range 0-28.5). The majority of patients (91%) received IV antibiotics preimplant, while 42% of patients received IV antibiotics postprocedure. The median length of hospitalization following Micra implant was 2 days (IQR, 1-7). During follow-up, two patients died from sepsis and four patients required system upgrade, of which two patients received Micra to provide temporary pacing support. There were no Micra devices explanted due to infection.

Conclusion: Implantation of the Micra transcatheter pacemaker is safe and feasible in patients with a recent CIED infection. No recurrent infections that required Micra device removal were seen. Leadless pacemakers appear to be a safe pacing alternative for patients with CIED infection who undergo extraction.

Keywords: Micra; cardiac implantable electronic device infection; leadless pacemakers; permanent pacing; transcatheter pacemaker.

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Figures

Figure 1
Figure 1
Kaplan‐Meier survival curve following micra implant. All cause death rate for patients implanted with a Micra device within 30 days of CIED extraction due to infection. Kaplan‐Meier rate at 12 months postimplant is depicted. CIED, cardiac implantable electronic device
See this image and copyright information in PMC

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