Very high pacing thresholds during long‐term follow‐up predicted by a combination of implant pacing threshold and impedance in leadless transcatheter pacemakers
| Autor: | José María Tolosana, Eduard Guasch, Margarida Pujol-López, Jose Apolo, Rodolfo San Antonio, Ivo Roca-Luque, Emilce Trucco, Lluís Mont, Fredy Chipa-Ccasani, Josep Brugada |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pacemaker Artificial Time Factors Long term follow up 030204 cardiovascular system & hematology Pacemaker system Young Adult 03 medical and health sciences Electric Power Supplies 0302 clinical medicine Physiology (medical) Electric Impedance Humans Electrical performance Medicine In patient 030212 general & internal medicine Aged Aged 80 and over business.industry Cardiac Pacing Artificial Area under the curve Arrhythmias Cardiac Sequential combination Equipment Design Middle Aged Predictive value Treatment Outcome Female Implant Cardiology and Cardiovascular Medicine Nuclear medicine business |
| Zdroj: | Journal of Cardiovascular Electrophysiology. 31:868-874 |
| ISSN: | 1540-8167 1045-3873 |
| Popis: | Background Micra transcatheter pacemaker system (TPS) usually achieves low implant pacing threshold (IPT). However, IPT may increase in some patients during follow-up. Aim To apply implant parameters in predicting long-term occurrence of very high pacing threshold (VHPT) in patients with Micra-TPS. Methods A cohort of 110 consecutive patients implanted with a Micra-TPS from 2014 to 2018 was evaluated at discharge and at 1, 12, 24, 36, and 48 months follow-up. VHPT was defined as greater than 2 V/0.24 ms. VHPT predictors were identified. Results Micra-TPS was implanted successfully in 108 patients (98.2%). During a mean follow-up of 24 ± 16 months, 18 patients (16.7%) died of causes nonpacemaker-related, and 4 (3.8%) developed VHPT. Patients with VHPT had higher IPT and lower implant impedance than patients with non-VHPT: 1 ± 0.31 vs 0.55 ± 0.29 V/0.24 ms (P = .003) and 580 ± 59 vs 837 ± 232 Ω (P = .03), respectively. IPT and impedance had excellent discriminative power to predict VHPT (area under the curve: 0.85 ± 0.07 and 0.91 ± 0.05, respectively). Negative predictive value (NPV) of IPT ≤ 0.5 V/0.24 ms was 100%; positive predictive value (PPV) was 8% throughout follow-up. Implant impedance ≤ 600 Ω had NPV of 99% throughout follow-up, whereas PPV varied: 16%, 21%, 16%, and 28% at 1, 12, 24, and 36 months, respectively. Sequential combination of IPT greater than 0.5 V/0.24 ms and impedance ≤ 600 Ω improved PPV to 25%, 35%, 27%, and 44%, respectively, whereas NPV remained 99% throughout follow-up. Conclusion Despite favorable long-term electrical performance of Micra-TPS, a small percent of patients developed VHPT during follow-up. A sequential combination of IPT and impedance could allow the implanter to identify patients who will develop VHPT during long-term follow-up. |
| Databáze: | OpenAIRE |
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