Benefits
One major benefit of LPs over transvenous systems is the low risk of
infection, which is especially important in patients with artificial
heart valves. Prosthetic valve endocarditis is the most common form of
endocarditis, affecting approximately 4.5% of AVR patients (8). The
presence of a cardiac implantable electronic device (CIED) is an
independent risk factor (1.6x) for prosthetic valve endocarditis (9).
The relationship is likely explained by CIED infection causing
bacteremia and seeding of prosthetic valves. Armed with this knowledge,
some electrophysiologists are reticent to perform early implantation of
a CIED, particularly in post-operative patients who often have
indwelling vascular catheters and chest tubes. The current study
demonstrates a high rate of late AV recovery, consistent with previously
studies that show up to 40% late recovery in AV conduction following
valve intervention (10). For those patients with recovery, the ability
to program the device “off” obviates the safety issues that can arise
in comparison to the unpredictable asynchronous behaviors of a
transvenous system at EOL. Thus, LPs could be considered a bridge to AV
conduction recovery with a minimal hardware footprint for many of these
patients.