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. 2023 Nov;34(11):2233-2242.
doi: 10.1111/jce.16046. Epub 2023 Sep 13.

Association of leadless pacing with ventricular and valvular function

Kelly Arps  1 , Bicong Li  1 , John Carson Allen Jr  1 , Fawaz Alenezi  1 , Camille Frazier-Mills  1 , Sana M Al-Khatib  1 , Kevin P Jackson  1 , Larry R Jackson 2nd  1 , Kevin L Thomas  1 , Jonathan P Piccini  1
Affiliations

Association of leadless pacing with ventricular and valvular function

Kelly Arps et al. J Cardiovasc Electrophysiol. 2023 Nov.

Abstract

Background: Traditional transvenous pacemakers are associated with worsening tricuspid valve function due to lead-related leaflet impingement, as well as ventricular dysfunction related to electromechanical dyssynchrony from chronic right ventricular (RV) pacing. The association of leadless pacing with ventricular and valvular function has not been well established. We aimed to assess the association of leadless pacemaker placement with changes in valvular regurgitation and ventricular function.

Methods and results: Echocardiographic features before and after leadless pacemaker implant were analyzed in consecutive patients who received a leadless pacemaker with pre- and postprocedure echocardiography at Duke University Hospital between November 2014 and November 2019. Valvular regurgitation was graded ordinally from 0 (none) to 3 (severe). Among 54 patients, the mean age was mean age was 70.1 ± 14.3 years, 24 (44%) were women, and the most frequent primary pacing indication was complete heart block in 24 (44%). The median RV pacing burden was 45.4 (interquartile range [IQR] 3.5-97.0). On echocardiogram performed 8.9 months (IQR 4.5-14.5) after implant, there was no change in the average severity of tricuspid regurgitation (mean change 0.07 ± 1.15, p = .64) from pre-procedure echocardiogram. We observed a decrease in the average left ventricular ejection fraction (LVEF) (52.3 ± 9.3 to 47.9 ± 12.1, p = .0019) and tricuspid annular plane systolic excursion (TAPSE) (1.8 ± 0.6 to 1.6 ± 0.4, p = .0437). Thirteen patients (24%) had absolute drop in LVEF of ≥10%.

Conclusion: We did not observe short term worsening valvular function in patients with leadless pacemakers. However, consistent with the pathophysiologic impact of RV pacing, leadless pacing was associated with a reduction in biventricular function.

Keywords: LVEF; TAPSE; leadless pacemaker; tricuspid regurgitation.

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Figures

Figure 1.
Figure 1.
Patient selection
Figure 2.
Figure 2.. Change in LVEF among among patients with leadless pacemaker
On echocardiogram performed 10.5 ±7.7 months after leadless pacemaker implant, average LVEF decreased from 52.3 ± 9.3 to 47.9 ± 12.1 (p=0.0019). 13 patients had absolute decrease in LVEF by ≥10%. LVEF, left ventricular ejection fraction.
Figure 3.
Figure 3.. Linear regression analysis on LVEF progression after Micra leadless pacemaker implant and RV pacing percentage
Regression analysis of LVEF progression (post-implant minus pre-implant value) and RV pacing, revealing positive correlation between worsening LVEF and higher burden of RV pacing (R2 = 0.0748, adjusted R2 = 0.0537). LVEF, left ventricular ejection fraction, VP, ventricular pacing
Figure 4.
Figure 4.. Alluvial diagram of tricuspid regurgitation severity pre- and post- leadless pacemaker implant.
Change in TR grade after leadless pacemaker implant. There was no significant change in the average severity calculated using an ordinal scale (no regurgitation = 0, mild regurgitation = 1, moderate regurgitation = 2, severe regurgitation = 3. TR, tricuspid regurgitation
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Comment in

References

    1. Hai J-J, Chan Y-H, Lau C-P, Tse H-F: Single-chamber leadless pacemaker for atrial synchronous or ventricular pacing. Pacing Clin Electrophysiol 2020; 43:1438–1450. - PubMed
    1. El-Chami MF, Johansen JB, Zaidi A, et al.: Leadless pacemaker implant in patients with pre-existing infections: Results from the Micra postapproval registry. J Cardiovasc Electrophysiol 2019; 30:569–574. - PMC - PubMed
    1. Lin G, Nishimura RA, Connolly HM, Dearani JA, Sundt TM, Hayes DL: Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardioverter-defibrillator leads. J Am Coll Cardiol 2005; 45:1672–1675. - PubMed
    1. Gelves-Meza J, Lang RM, Valderrama-Achury MD, et al.: Tricuspid Regurgitation Related to Cardiac Implantable Electronic Devices: An Integrative Review. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr 2022; 35:1107–1122. - PubMed
    1. Al-Mohaissen MA, Chan KL: Prevalence and mechanism of tricuspid regurgitation following implantation of endocardial leads for pacemaker or cardioverter-defibrillator. J Am Soc Echocardiogr 2012; 25:245–252. - PubMed

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