Limitations
The best predictor of drop in LVEF within the cohort was a history of heart failure with reduced ejection fraction. Half of the patients with a history of heart failure with reduced ejection fraction (11/22) experienced a drop in LVEF of 10% or more. Thus, these patients would likely be better served with CRT or conduction system pacing unless there is a contraindication to transvenous pacing. LPs could be considered in patients in whom LVEF is expected to recover, but accurate clinical prediction tools for LVEF recovery are lacking and caution should be used. In contrast, the AV MICRA group had a trend towards lower LVEF, it was not clinically meaningful (56.1 vs. 54.6%). While limited, historical data have shown valve intervention may promote restoration of sinus rhythm (11). Thus, based on the likely benefit of maintaining AV synchrony, we suggest preferential use of MICRA AV over MICRA VR unless compelling evidence for permanent atrial fibrillation.
Overall, LPs performed well in this retrospective, single center study of post-operative patients with relatively low rates of reintervention and complications. However, the evidence for drop in LVEF suggests that this patient population would benefit from a prospective study to better understand the net clinical effect of LP vs transvenous pacemaker in this population.
References
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