Impact of leadless pacemakers on valvular and cardiac function
- Hongfei Yu,
- Yu Sun,
- Wei Xu,
- Jian Bai
Hongfei Yu
Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital
Author ProfileYu Sun
Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital
Author ProfileJian Bai
Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital
Author ProfileAbstract
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2.1 Background The impact of leadless pacemaker (LP) implantation on
valvular and cardiac function remains controversial. This study aims to
examine the cardiac and valvular functions before and after the
implantation of the LP at our centre and to identify possible
influencing factors. 2.2 Methods and results We included patients who
underwent their first Micra LP implantation at our center from March
2019 to September 2023. These patients received transthoracic
echocardiography (TTE) on average 361 days post-operation. We included
56 patients who underwent LP implantation, of which 15 (26.8%) LPs were
placed in the low septum, 37 (66.1%) in the mid septum, and 4 (7.1%)
in the high septum of the RV. Approximately one year after implantation,
10 patients (17.9%) experienced more severe of tricuspid regurgitation
(TR). However, no significant differences were observed in tricuspid,
mitral, or aortic valve regurgitation before and after the procedure.
There was a slight improvement in LVEF [59.0 (IQR: 56.9-60.4) vs. 60.0
(IQR: 57.9-62.4) %, p=0.035] and a reduction in left ventricular
end-diastolic diameter [5.1 (IQR: 4.7-5.3) vs. 4.80 (IQR: 4.6-5.2) cm,
p=0.014] after procedure. Compared to the unchanged TR group, the TR
progression group had a higher age [67.0 (IQR: 55.0-76.0) vs. 84.5
(IQR: 74.5-90.5) years, p=0.001] and longer procedure times [50.0
(IQR: 40.0-62.5) vs. 62.5 (IQR: 58.8-76.3) minutes, p=0.044].
Additionally, advanced age [OR: 1.2 (1.1-1.3), p=0.005] and longer
procedural time [OR: 1.1 (1.0-1.1), p=0.030] were identified as
independent predictors of TR. 2.3 Conclusions Placing the Micra LP in
the septum of the RV can potentially improve left heart function and
structure. Mid or lower septal implantation might be a preventive
measure against TR worsening post-procedure. The primary causes of TR
deterioration are advanced age and extended procedural duration.