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. 2022 Nov;45(11):1310-1315.
doi: 10.1111/pace.14545. Epub 2022 Jun 13.

Micra AV leadless pacemaker implantation after transcatheter aortic valve implantation

Alexis Mechulan  1 , Sébastien Prevot  1 , Angélique Peret  1 , Lyassine Nait-Saidi  1 , Ichem Miliani  1 , Lauriane Leong-Feng  1 , Elisabeth Leude-Vaillant  2 , Alain Vaillant  2 , Alain Cornen  1 , Bernard Latiere  1 , Marie-Paule Giacomoni  1 , Frédéric Collet  1 , Vincent Bechet  1 , Ahmed Bouharaoua  1 , Pierre Dieuzaide  1
Affiliations

Micra AV leadless pacemaker implantation after transcatheter aortic valve implantation

Alexis Mechulan et al. Pacing Clin Electrophysiol. 2022 Nov.

Abstract

Background: Transvenous pacemaker (PM) implantation is a complication in patients undergoing transcatheter aortic valve implantation (TAVI). Recently, a second generation of leadless PMs able of atrioventricular (AV) synchronous pacing has been introduced and could be an alternative when ventricular pacing is required after TAVI. Real-world data on Micra AV after TAVI are still lacking. Our aim was to determine the per- and post-procedural outcomes in patients with Micra AV leadless PM implantation after TAVI.

Methods: A total of 20 consecutive patients underwent Micra AV leadless PM implantation after TAVI between November 2020 and June 2021.

Results: The main indication for ventricular pacing was high-degree AV block (55% of patients) and left bundle branch block (LBBB) associated with prolonged HV interval (45% of patients). At discharge, mean (SD) ventricular pacing threshold was 0.397 ± 0.11 V at 0.24 ms and ventricular impedance was 709.4 ± 139.1 Ω. At 1-month follow-up, 95% of patients were programmed in VDD pacing mode. Mean (SD) ventricular pacing threshold was 0.448 ± 0.094 V at 0.24 ms. In patients with ventricular> pacing > 90% (n = 5), mean AM-VP was 72.5% ± 8.3%. Pacing threshold at 1 month was not significantly different compared to discharge (p = .1088). Mean (SD) impedance was 631.0 ± 111.9 Ω, which remained stable at discharge (p = .0813). No procedural complications occurred during implantation. At 1-month follow-up, two patients displayed atrial under-sensing.

Conclusions: Micra AV leadless PM implantation after TAVI is associated with a low complication rate and good device performance at 1-month post-implantation.

Keywords: leadless pacemaker implantation; outcome; transcatheter aortic valve implantation.

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Figures

FIGURE 1
FIGURE 1
Fluoroscopy view of a Micra AV leadless pacemaker during implantation. TAVI valve is marked by 1, 2 indicates the Micra AV, 3 indicates the MICRA deployment catheter and 4 is the temporary pacing lead
FIGURE 2
FIGURE 2
Micra AV leadless pacemaker measurement at discharge and at 1‐month follow‐up. (A) Pacing threshold (V) at 0.24 ms. (B) Impedance (Ω). (C) Percentage ventricular pacing. Data shown are means ± SD
See this image and copyright information in PMC

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