Leadless pacemaker perforations: Clinical consequences and related device and user problems.

Autor: Hauser RG; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA., Gornick CC; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA., Abdelhadi RH; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA., Tang CY; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA., Kapphahn-Bergs M; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA., Casey SA; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA., Okeson BK; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA., Steele EA; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA., Sengupta JD; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2022 Feb; Vol. 33 (2), pp. 154-159. Date of Electronic Publication: 2022 Jan 07.
DOI: 10.1111/jce.15343
Abstrakt: Background: Cardiac perforation during leadless pacemaker implantation is more likely to require intervention than perforation by a transvenous lead. This study reports the consequences of Micra pacemaker perforations and related device and operator use problems based on information the manufacturer has submitted to the Food and Drug Administration (FDA).
Methods: FDA's Manufacturer and User Facility Device Experience (MAUDE) database was searched for Micra perforations. Data extracted included deaths, major adverse clinical events (MACEs), and device and/or operator use problems.
Results: Between 2016 and July 2021, 563 perforations were reported within 30 days of implant and resulted in 150 deaths (27%), 499 cardiac tamponades (89%), 64 pericardial effusions (11%), and 146 patients (26%) required emergency surgery. Half of perforations were associated with 139 (25%) device problems, 78 (14%) operator use problems, and 62 (11%) combined device and operator use problems. Inadequate electrical measurements or difficult positioning were the most frequent device problems (n = 129); non-septal implants and perforation of other structures were the most frequent operator use problems (n = 69); a combined operator use and device problem resulted in 62 delivery system perforations. No device or operator use problem was identified for 282 perforations (50%), but they were associated with 78 deaths, 245 tamponades, and 57 emergency surgeries.
Conclusion: The Micra perforations reported in MAUDE are often associated with death and major complications requiring emergency intervention. Device and use problems account for at least half of perforations. Studies are needed to identify who is at risk for a perforation and how MACE can be avoided or mitigated.
(© 2021 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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