Cardiovascular Implantable Electronic Devices -> Monitoring & Outcomes: -> Monitoring & Follow-up D-PO05 - Poster Session V (ID 39) Poster

D-PO05-079 - Leadless Pacemaker Implantation Under Direct Visualization During Cardiac Surgery (ID 538)


Background: Pacemaker implantation is required after valve surgery in 4-13%, depending on the type of surgery and patient characteristics. Intra-operative implantation of a leadless pacemaker (LP) is an attractive alternative for patients with an indication for, or are at high-risk for, permanent pacing.
Objective: To report outcomes of intra-operative LP implantation under direct visualization.
Methods: Retrospective analysis of consecutive pts with LPs implanted under direct visualization at the time of valve surgery, using the standard delivery system. Interrogations were immediately post-bypass, POD#1 and at office follow-up.
Results: The cohort (n=14; 67±17 yrs old, 36% male, 79% AF, 14% DM, 50% HTN, 29% prior CIED) had SSS in 50%, AF with bradycardia in 14%, AV block in 7%, and high risk for AV block in 29%. Pacing thresholds and sensing were normal (1.0, 0.6 & 0.8 V at 0.24ms, and 11.8, 12.3 & 11.7 mV, at implant, POD#1 and F/U, respectively). Impedance was high normal immediately post-bypass (1069 Ohms), and reduced to normal on POD#1 (761, and 641 Ohms at F/U). In 10 pts (71%), implantation of temporary epicardial pacing wires was not performed due to stability of LP performance. The mean ICU length of stay was shorter in the group not receiving epicardial wires (2.8 vs 5.2 days). There were no procedural complications, infections or pacing issues at F/U (at 82 ± 36 days). All implants were performed in ≤5 min.
Conclusion: Intra-operative LP implantation at the time of valve surgery is safe and feasible, and may shorten ICU stay. This strategy could be employed for patients at high risk for needing chronic single-chamber pacing or intermittent pacing due to AV block and/or conversion pauses.