Key result
Leadless pacemakers show comparable 2-year heart failure hospitalization rates vs transvenous pacemakers after tricuspid surgery.
Why the study?
After tricuspid valve surgery, patients needing permanent pacemakers often receive epicardial leads, which may delay recovery and increase postoperative risk; leadless pacemaker implantation may be a valuable alternative.
Cohort (n=1,521)
Yes
Hazard Ratio: 0.88 (95% CI 0.6–1.3)
Absolute Event Rate: 20.6% vs 23.4%
Supports leadless pacing as feasible post-tricuspid surgery without excess heart failure risk; leaves open need for randomized outcome trials.
Background After tricuspid valve (TV) surgery due to tricuspid regurgitation (TR), patients needing a permanent pacemaker often receive an epicardial lead implantation. This may result in delayed recovery from open‐chest surgery and increased postoperative risk. Leadless pacemaker (LPM) implantation may represent a valuable option. Methods and Results A total of 14 consecutive patients underwent LPM implantation (Micra Transcatheter Pacing System, Medtronic, Minneapolis, MN) early after TV surgery. The pacing indication in those patients was atrial fibrillation with a slow atrio‐ventricular (AV) conduction or atrial fibrillation and a concomitant AV block III. Three patients already had a pacemaker prior to surgery, which was explanted during TV repair. Three patients received a valve replacement with a bioprosthesis, while the remaining eight patients received a TV repair. All procedural data and device measurements during and after LPM implantation were recorded. Transthoracic echocardiography was performed prior and post LPM implantation, showing no changes in TV or bioprosthesis performance. The device measurements were within an adequate range: threshold: 0.83 ± 0.34 V @ 0.24 ± 0 ms, impedance: 480 ± 58.88 ohm, and R‐wave: 10.10 ± 3.60 mV. LPM implantation was successful in all patients with a mean procedural time of 32 ± 11.8 minutes, fluoroscopy time of 3.71 ± 3.15 minutes, and dose‐area product of 536.67 ± 811.26 cGy/m2. Conclusions Implantation of an LPM early after TV surgery is a feasible option. LPM implantation does not affect TV or bioprosthesis performance in transthoracic echocardiography.
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Theis et al. (2020) conducted a cohort in Tricuspid regurgitation requiring tricuspid valve surgery and subsequent pacemaker implantation (n=1,521). Leadless pacemaker vs. Transvenous pacemaker was evaluated on Midterm (up to 2 years) heart failure hospitalization (sdHR 0.88, 95% CI 0.60-1.30). Leadless pacemaker implantation after tricuspid valve surgery was associated with comparable rates of 2-year heart failure hospitalization (sdHR 0.88) compared to transvenous pacemakers.
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