Key result
Review suggests retrieving non-functioning leadless pacemakers over adjacent placement to limit hardware and prevent interference.
Why the study?
The optimal end-of-life strategy for leadless pacemaker therapy in patients with a single-chamber pacing indication is undefined, with mixed early experience regarding retrieval feasibility and safety.
Retrieval of non-functioning leadless pacemakers at end-of-life may be preferable to placing an adjacent device to limit hardware and interference, but long-term prospective data are needed to define the optimal strategy.
May support retrieval of non-functioning leadless pacemakers to minimize hardware; leaves open optimal end-of-life strategy pending prospective data.
The clinically available leadless pacemakers for patients with a single-chamber pacing indication have shown to be safe and effective. However, the optimal end-of-life strategy of this novel technique is undefined. Suggested strategies comprise of (a) placing an additional leadless device adjacent to the leadless pacemaker, or (b) retrieving the non-functioning leadless pacemaker and subsequently implanting a new device. Although initial studies demonstrate promising results, early experience of acute and mid-term retrieval feasibility and safety remains mixed. We suggest that the approach of leadless pacemaker retrieval is more appealing to limit the amount of non-functioning intracardiac hardware. In addition, potential risks for device-device interference, and unknown long-term complications associated with multiple intracardiac devices are prevented. The potential inability to retrieve chronically implanted leadless pacemakers limits the application of this novel technology. Therefore, long-term prospective analysis is required to define the most optimal end-of-life strategy.
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Beurskens et al. (2017) conducted a review in Patients with a single-chamber pacing indication requiring end-of-life management of leadless pacemakers. Leadless pacemaker retrieval vs. Placing an additional leadless device adjacent to the leadless pacemaker was evaluated. Retrieval of non-functioning leadless pacemakers is suggested as the preferred end-of-life strategy to limit intracardiac hardware and prevent device interference, though long-term data is needed.
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