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Case Reports
. 2018 Nov 1;35(1):139-141.
doi: 10.1002/joa3.12129. eCollection 2019 Feb.

One stage atrioventricular nodal ablation and leadless pacemaker implantation for refractory atrial fibrillation

Chu-Pak Lau  1 , Kathy Lai-Fun Lee  1
Affiliations
Case Reports

One stage atrioventricular nodal ablation and leadless pacemaker implantation for refractory atrial fibrillation

Chu-Pak Lau et al. J Arrhythm. .

Abstract

Atrioventricular nodal (AVN) ablation and right ventricular (RV) pacing is recommended for refractory atrial fibrillation (AF) and tachycardia-bradycardia syndrome. Three AF patients (mean age 83, range 79-89 years) underwent AVN ablation and transvenous leadless pacemaker Micra™ implantations using the same venous access without anticoagulation interruption. Satisfactory pacing 0.59 (0.50-0.63) V at 0.24 ms and sensing 11.2 (6.3-15.6) mV were achieved within 1-3 deployments. There were no vascular complications nor device dislodgment. Durable pacemaker parameters and VVIR pacing were achieved. Combined AVN ablation and leadless pacemaker implantation is feasible and safe, and avoids pacemaker pocket hematoma and bleeding complications in patients on uninterrupted anticoagulation.

Keywords: ablation; atrial fibrillation; leadless pacemaker; rate adaptation; sick sinus syndrome.

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Figures

Figure 1
Figure 1
One stage antrioventricular nodal (AVN) ablation and implantation of leadless pacemaker in patient 3 with tachycardia‐bradycardia syndrome and fast atrial fibrillation. Right anterior oblique cineangiogram views during AVN ablation (A), and implantation of the leadless pacemaker Micra™ TCP prior to its complete detachment from the delivery sheath (B). ABL = ablation catheter, C = Micra™ delivery catheter, RV = RV temporary pacing catheter, TCP = Micra™ transcatheter pacemaker
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