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Comparative Study
. 2023 Jun;34(6):1418-1426.
doi: 10.1111/jce.15925. Epub 2023 May 10.

Anatomical location of leadless pacemaker and the risk of pacing-induced cardiomyopathy

Ghanshyam Shantha  1 , Jonathan Brock  1 , Matthew Singleton  2 , Patrick Kozak  1 , George Bodziock  1 , Natalie Bradford  1 , Abhishek Deshmukh  3 , Jackson J Liang  4 , Naga Venkata K Pothineni  5 , Patrick Hranitzky  6 , Patrick Whalen  1 , Prashant D Bhave  1
Affiliations
Comparative Study

Anatomical location of leadless pacemaker and the risk of pacing-induced cardiomyopathy

Ghanshyam Shantha et al. J Cardiovasc Electrophysiol. 2023 Jun.

Abstract

Background: It is unclear if the location of implantation of the leadless pacemaker (LP) makes a difference in the incidence of pacing-induced cardiomyopathy (PICM).

Aim: The aim of this study was to compare the incidence of PICM based on the location of implantation of LP.

Methods: A total of 358 consecutive patients [women: 171 (48%), mean age: 73 ± 15 years] with left ventricular ejection fraction (EF) > 50%, who received an LP (Micra) between January 2017 and June 2022, formed the study cohort. Micra-AV and Micra-VR were implanted in 122 (34%) and 236 (66%) patients, respectively. Fluoroscopically, the location of implantation of LP in the interventricular septum (IS) was divided into two equal halves (apex/apical septum [AS] and mid/high septum [HS]). During follow-up, PICM was defined as an EF drop of ≥10%.

Results: LP was implanted in 109 (34%) and 249 (66%) patients at AS and HS locations, respectively. During a mean 18 ± 8 months follow-up, 28 patients (7.8%) developed PICM. Among the 249 patients with HS placement of LP, 10 (4%) developed PICM, whereas among the 109 patients with AS placement of LP, 18 (16.5%) developed PICM (p = .002). AS location was associated with a higher risk of PICM compared to HS locations (adjusted hazard ratio: 4.42, p < .001).

Conclusion: AS location of LP was associated with a higher risk of PICM compared to HS placement. Larger randomized studies are needed to confirm our findings.

Keywords: cardiomyopathy; complications; device therapy; interventricular septum; leadless pacemaker.

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References

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