Long-Term Safety and Efficacy of Intraoperative Leadless Pacemaker Implantation During Valve Surgery

Connor P. Oates, Karel T.N. Breeman, Marc A. Miller, Percy Boateng, Aarti Patil, Daniel R. Musikantow, Elbert Williams, Ismail El-Hamamsy, Morgan L. Montgomery, Benjamin S. Salter, Chartaroon Rimsukcharoenchai, Dimosthenis Pandis, Menachem M. Weiner, Srinivas R. Dukkipati, Anelechi Anyanwu, Vivek Y. Reddy, David H. Adams, Ahmed M. El-Eshmawi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Intraoperative implantation of leadless cardiac pacemakers (LCPs) under direct visualization during cardiac surgery is a novel strategy to provide pacing to patients with an elevated risk of postoperative conduction disorders or with a preexisting pacing indication undergoing valve surgery. Objectives: This study sought to evaluate the long-term safety and efficacy of intraoperative LCP implantation in 100 consecutive patients. Methods: Retrospective single-center cohort study of consecutive patients (n = 100) who underwent intraoperative LCP implantation during valve surgery. Safety and efficacy were assessed at implantation and follow-up visits. Results: A total of 100 patients (age 68 ± 13 years, 47% female) underwent intraoperative LCP implantation. The surgery involved the tricuspid valve in 99 patients (99%), including tricuspid valve repair in 59 (59%) and tricuspid valve replacement in 40 (40%). Most of the patients (78%) underwent multivalve surgery. The indication for LCP implantation was elevated risk of postoperative atrioventricular block in 54% and preexisting bradyarrhythmias in 46%. LCP implantation was successful in all patients. During a median of 10.6 months (IQR: 2.0-22.7 months) of follow-up, no device-related complications occurred. At 12-month follow-up, the pacing thresholds were acceptable (≤2.0 V at 0.24 milliseconds) in 95% of patients. Conclusions: Intraoperative LCP implantation under direct visualization is a safe strategy to provide permanent pacing in patients undergoing valve surgery, with a postoperative electrical performance comparable to percutaneously placed LCPs.

Original languageEnglish
Pages (from-to)2224-2233
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume10
Issue number10
DOIs
StatePublished - Oct 2024

Keywords

  • efficacy
  • leadless cardiac pacemaker
  • permanent pacemaker
  • safety
  • valve surgery

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