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
- Huang J, Bhatia NK, Lloyd MS, et al. Outcomes of leadless pacemaker
implantation after cardiac surgery and transcatheter structural valve
interventions. J Cardiovasc Electrophysiol . Article in press.
- Carroll JD, Mack MJ, Vemulapali S, et al. STS-ACC TVT Registry of
Transcatheter Aortic Valve Replacement. J Am Coll Cardiol . 2020
Nov; 76 (21): 2492-2516.
- El-Sabawi B, Welle GA, Cha YM, et al. Temporal Incidence and
Predictors of High-Grade Atrioventricular Block After Transcatheter
Aortic Valve Replacement. JAHA . 2021 May, 10 (10).
- Goldman BS, Hill TJ, Weisel RD, et al. Permanent pacing after
open-heart surgery: acquired heart disease. PACE . 1984 May, 7
(3): 367-371.
- El-Chami MF, Bockstedt L, Longacre C, et al. Leadless vs. transvenous
single-chamber ventricular pacing in the Micra CED study: 2-year
follow-up. European Heart Journal . 2022, 43: 1207-1215.
- Sultan A, Scheurlen C, Wormann J, et al. First long-term outcome data
for the MicraVRâ„¢ transcatheter pacing system: data from the largest
prospective German cohort. Clin Res Cardiol . 2023.
- Sanchez R, Nadkarni A, Buck B, et al. Incidence of pacing-induced
cardiomyopathy in pacemaker-dependent patients is lower with leadless
pacemakers compared to transvenous pacemakers. J Cardiovasc
Electrophysiol . 2021 Feb; 32 (2): 477-483.
- Butt JH, Ihlemann N, De Backer O, et al. Long-Term Risk of Infective
Endocarditis After Transcatheter Aortic Valve Replacement. J Am
Coll Cardiol. 2019 Apr; 73 (13): 1646-1655.
- Ostergaard L, Valeur N, Bundgaard H, et al. Cardiac implantable
electronic device and associated risk of infective endocarditis in
patients undergoing aortic valve replacement. Europace . 2018
Oct; 20 (10):e164-e170.
- Rene AG, Sastry A, Horowitz JM, et al. Recovery of atrioventricular
conduction after pacemaker placement following cardiac valvular
surgery. J Cardiovasc Electrophysiol . 2013 Dec: 24(23):1383-7.
- Obadia JF, el Farra M, Bastien OH, et al. Outcome of atrial
fibrillation after mitral valve repair. J Thorac Cardiovasc
Surg . 1997 Aug; 114(2): 179-85.