Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Quality Measures & Complications D-PO05 - Poster Session V (ID 39) Poster

D-PO05-101 - Right Ventricular And Tricuspid Valve Function After Transcatheter Leadless Pacemaker Implantation - Results From A Large German Registry (ID 1267)

Abstract

Background: The Micra leadless pacemaker (LP) has been implemented into clinical routine. Lead induced tricuspid valve (TCV) disturbance should be unlikely after LP implantation. However, right-ventricular (RV) VVI pacing potentially impairs RV function (RV-Fx) and might cause tricuspid valve regurgitation (TCVR). Lately few smaller studies reported of TCV impairment after LP implantation. Data in this field is rare, incoherent and including the omitted Nanostim system.
Objective: This substudy of a largest German LP registry sought to investigate whether LP pacing has an impact on RV-Fx and TCV-Fx. This could be relevant in establishing LP as an alternative to VVI-systems, which cause TCVR and decrease of RV-Fx.
Methods: We investigated 123 TPS pts in two centers. Data of echocardiographic Follow-Up (FU) was collected from 19 (15%) pts (8 women [42%], age 79±9 years) in one center. Investigated parameters were left ventricular function, RV-Fx (TAPSE and basal RV), TCVR and systolic pulmonary artery pressure (SPAP).
Results: All underwent successful LP implantation. In two patients (11%) extraction of conventional VVI-devices was performed previously. All other pts were de-novo LP implantations. Mean percentage of RV pacing demand was 47%±40% during FU. After a median FU of 449 days there were no differences in LV-Fx (54.6%±8.4% vs. 55.8%±6.7%; p=0.28). Furthermore, RV-Fx evaluated by TAPSE (18.5mm±4.0mm vs. 19.3mm±5.1mm; p=0.53), basal RV (39mm±7mm vs. 38mm±6mm; p=0.25) and SPAP (35 mmHg±22mmHg vs. 31mmHg±20 mmHg; p=0.16) showed no differences before and after LP pacing. After LP implantation 7 (37%) pts showed milder TR than before, 9 (47%) showed no difference and 3 (16%, all de-novo) worsened regarding TCVR. All of these were functional TCVR with concomitant mitral regurgitation and LV-Fx.
Conclusion: In this substudy implantation of the Micra LP with a high pacing demand was neither associated with impairment of TCV function nor RV dysfunction. We assume that the device size (Nanostim vs. Micra) and location of deployment (high septal vs. apical) may lead to different outcomes and explain deviant findings of lately published studies. Further prospective studies comparing conventional VVI with LP systems are ongoing to underline potential benefits of LPs.
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