Acute pacing threshold elevation during simultaneous Micra leadless pacemaker implantation and AV node ablation: Clinical cases, computer model and practical recommendations.

Autor: Racine HP; Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (IUCPQ-UL), Quebec, Canada., Dognin N; Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (IUCPQ-UL), Quebec, Canada., Zhao Y; Medtronic Inc, Cardiac Rhythm Management, Minneapolis, USA., Plourde B; Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (IUCPQ-UL), Quebec, Canada., Steinberg C; Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (IUCPQ-UL), Quebec, Canada., Whitman T; Medtronic Inc, Cardiac Rhythm Management, Minneapolis, USA., Philippon F; Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (IUCPQ-UL), Quebec, Canada.
Jazyk: angličtina
Zdroj: Pacing and clinical electrophysiology : PACE [Pacing Clin Electrophysiol] 2023 Oct; Vol. 46 (10), pp. 1269-1277. Date of Electronic Publication: 2023 Sep 04.
DOI: 10.1111/pace.14814
Abstrakt: Background: In patients with refractory atrial fibrillation (AF), atrioventricular nodal (AVN) ablation and permanent pacemaker implantation is recommended. The Micra Transcatheter Pacing System (Micra) is a single chamber leadless pacemaker (LPM) and thus offers the possibility of AV node (AVN) ablation in the same procedure. Pacing threshold (PT) elevation after radiofrequency (RF) ablation is a potential complication.
Methods: We conducted a single center retrospective cohort study. Patients implanted with a Micra (n = 84) and concomitant or delayed AVN ablation (n = 12) from 2014 to 2022 were included. Two cases of acute Micra PT elevation immediately following RF AVN ablation required device retrieval and implantation of a new Micra. Procedural characteristics and electrophysiological parameters were analyzed, and a computer model was performed to determine factors responsible for acute PT elevations.
Results: A total of 84 patients were included. Mean age was 74 ± 10 and 48% were women. Twelve patients (14%) underwent AVN ablation. Two patients had acute PT elevation requiring device retrieval despite no direct contact of the ablation catheter with the Micra. Computer modeling shows that significant dissipated power due to electrical field coupling can occur at the tip or ring electrode if the catheter is not kept at a safe distance (≥35 mm) from the Micra when a maximum power of 100 W is delivered.
Conclusion: Concurrent AVN ablation and Micra implantation is safe in most patients. To prevent acute PT elevation, keeping a safe distance of ≥35 mm from the tip and ring electrodes of the Micra and using lower power output may prevent this complication.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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