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J Cardiovasc Electrophysiol. 2019 Apr;30(4):569-574. doi: 10.1111/jce.13851. Epub 2019 Jan 28.

Leadless pacemaker implant in patients with pre-existing infections: Results from the Micra postapproval registry.

Author information

1
Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia.
2
Department of Cardiology, Odense University Hospital, Odense, Denmark.
3
Division of Cardiology, Central Manchester University Hospitals, NHS Foundation Trust, Manchester, United Kingdom.
4
Department of Heart Disease, Haukeland University Hospital.
5
Department of Clinical Science, University of Bergen, Bergen, Norway.
6
Division of Cardiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
7
Division of Cardiology, Service de cardiologie, CHU de Brest, Brest, France.
8
Division of Cardiology, University of Montpellier, CHRU Montpellier, PHYMEDEXP, CNRS, INSERM, Montpellier, France.
9
Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama.
10
Division of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
11
Division of Cardiology, Kyorin University Hospital, Tokyo, Japan.
12
Medtronic, plc, Mounds View, Minnesota.
13
Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.

Abstract

INTRODUCTION:

Leadless pacemakers may provide a safe and attractive pacing option to patients with cardiac implantable electronic device (CIED) infection. We describe the characteristics and outcomes of patients with a recent CIED infection undergoing Micra implant attempt.

METHODS AND RESULTS:

Patients with prior CIED infection and device explant with Micra implant within 30 days, were identified from the Micra post approval registry. Procedure characteristics and outcomes were summarized. A total of 105 patients with prior CIED infection underwent Micra implant attempt ≤30 days from prior system explant (84 [80%] pacemakers and 13 [12%] ICD/CRT-D). All system components were explanted in 93% of patients and explant occurred a median of 6 days before Micra implant, with 37% occurring on the day of Micra implant. Micra was successfully implanted in 99% patients, mean follow-up duration was 8.5 ± 7.1 months (range 0-28.5). The majority of patients (91%) received IV antibiotics preimplant, while 42% of patients received IV antibiotics postprocedure. The median length of hospitalization following Micra implant was 2 days (IQR, 1-7). During follow-up, two patients died from sepsis and four patients required system upgrade, of which two patients received Micra to provide temporary pacing support. There were no Micra devices explanted due to infection.

CONCLUSION:

Implantation of the Micra transcatheter pacemaker is safe and feasible in patients with a recent CIED infection. No recurrent infections that required Micra device removal were seen. Leadless pacemakers appear to be a safe pacing alternative for patients with CIED infection who undergo extraction.

KEYWORDS:

Micra; cardiac implantable electronic device infection; leadless pacemakers; permanent pacing; transcatheter pacemaker

PMID:
30661279
DOI:
10.1111/jce.13851

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