Key result
Micra leadless pacemakers do not significantly alter tricuspid regurgitation severity.
Why the study?
Prior studies on leadless pacemakers and tricuspid regurgitation included a mix of device models; this study aimed to investigate the impact using only one leadless pacemaker model.
Does Micra leadless pacemaker implantation impact tricuspid regurgitation severity in adult patients?
Cohort (n=104)
No
Does Micra leadless pacemaker implantation impact tricuspid regurgitation severity in adult patients?
p-value: p=0.053
Micra leadless pacemaker implantation did not result in a statistically significant change in tricuspid regurgitation severity.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Taken together and without any available randomized study, LPM appeared not to worsen TV function after implantation over the short term. Should we be complacent that LPM therapy for bradycardia is safe from TR? While the overall TR severity was not different after LPM, a 28% worsening of TR in this study was observed, which was offset by reduction of TR after pacing, presumably due to pacing correction of bradycardia and cycle length variability.”
Should not yet change pacemaker choice for TR risk; leaves open whether Micra uniquely avoids lead-related regurgitation.
Background The association between conventional transvenous pacemaker leads and tricuspid regurgitation (TR) has been well described. Leadless pacemakers (LP) have risen as an alternative to conventional transvenous pacemakers in order to avoid lead associated complications. Prior studies have included a mix of leadless pacemaker types including: Nanostim, Micra, etc. This is the first study exploring only one model of LP. Purpose The purpose of the study was to investigate the impact of leadless pacemaker therapy on tricuspid regurgitation. Methods Adult patients who underwent Micra leadless pacemaker implantation at a single center from 2016 to 2022 were identified retrospectively. Patients who had an echocardiogram prior to the procedure and within 24 months after the procedure were included. Echocardiograms were reviewed to assess for change in presence or in severity of tricuspid regurgitation. Results There were 310 patients in total who received LP at our hospital. Of these, 104 met inclusion criteria. 189 patients were excluded because they did not have an echocardiogram before or after the procedure. 17 more were excluded because their post procedure echo was done more than 2 years later. The average age of our patient population was 78. Of the 104 total patients, 97 had some TR before LP implantation (Trace 41%, Trace-Mild 4%, Mild 31%, Mild-Moderate 7%, Moderate 13%, Moderate-Severe 1%, Severe 2%). After implantation, 34 patients had worsening TR (33%), 23 patients had improved TR (22%), and 47 patients had no change in TR severity (45%) p=0.053. Conclusion Overall, the results did not show a statistically significant improvement or worsening in TR severity after LP implantation. Further studies should be done to validate these findings, to evaluate the effect of a larger sample size, and to examine whether controlling for additional confounders maintains or contradicts this finding.
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Mendoza et al. (2023) conducted a cohort in Tricuspid regurgitation in pacemaker patients (n=104). Micra leadless pacemaker implantation vs. Pre-implantation baseline was evaluated on Change in presence or severity of tricuspid regurgitation (p=0.053). Micra leadless pacemaker implantation did not significantly alter tricuspid regurgitation severity, with 33% worsening, 22% improving, and 45% showing no change (p=0.053).
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