Initial experience with transcatheter pacemaker implantation for adults with congenital heart disease

BACKGROUND: Transvenous pacemaker systems have significant advantages over epicardial systems in patients with congenital heart disease (CHD). Frequently though, unique anatomic challenges preclude the use of transvenous leads. Although originally developed for patient with normal anatomy, leadless pacemaker systems have enormous potential in the CHD population. OBJECTIVE: To describe an initial experience with leadless pacemaker implantation in adult patients with CHD who were not the candidates for traditional transvenous pacing. METHODS: This was a retrospective review of the experience with Micra Transcatheter Pacing System implantation in adult patients with CHD. Patient demographics, clinical history, pacing indications, procedural details, clinical outcomes, and pacing characteristics at follow-up are reported. RESULTS: Three patients with intracardiac shunts or tricuspid valve disorders who underwent leadless pacemaker placement are described. Pacing indications included sinus node dysfunction in two and permanent atrial fibrillation with atrioventricular (AV) block in one. There were no procedural or thromboembolic complications over the follow-up period. Pacing characteristics were acceptable and ventricular pacing burden remained low except for the single patient with AV block. CONCLUSIONS: Leadless pacemaker systems are a viable pacing option for appropriately selected adult patients with CHD when transvenous pacing is not a suitable option.