Leadless cardiac pacemaker implantations after infected pacemaker system removals in octogenarians

Satoshi Higuchi; Ayako Okada; Morio Shoda; Daigo Yagishita; Satoshi Saito; Miwa Kanai; Shohei Kataoka; Kyoichiro Yazaki; Hiroaki Tabata; Hideki Kobayashi; Wataru Shoin; Takahiro Okano; Koji Yoshie; Koichiro Ejima; Koichiro Kuwahara; Nobuhisa Hagiwara

doi:10.11909/j.issn.1671-5411.2021.07.006

Volume 18 Issue 7

Jul. 2021

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Article Navigation > Journal of Geriatric Cardiology > 2021 > 18(7): 505-513

Please cite this article as: Higuchi S, Okada A, Shoda M, Yagishita D, Saito S, Kanai M, Kataoka S, Yazaki K, Tabata H, Kobayashi H, Shoin W, Okano T, Yoshie K, Ejima K, Kuwahara K, Hagiwara N. Leadless cardiac pacemaker implantations after infected pacemaker system removals in octogenarians. J Geriatr Cardiol 2021; 18(7): 505−513. DOI: 10.11909/j.issn.1671-5411.2021.07.006

Citation:

Please cite this article as: Higuchi S, Okada A, Shoda M, Yagishita D, Saito S, Kanai M, Kataoka S, Yazaki K, Tabata H, Kobayashi H, Shoin W, Okano T, Yoshie K, Ejima K, Kuwahara K, Hagiwara N. Leadless cardiac pacemaker implantations after infected pacemaker system removals in octogenarians. J Geriatr Cardiol 2021; 18(7): 505−513. DOI: 10.11909/j.issn.1671-5411.2021.07.006

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Leadless cardiac pacemaker implantations after infected pacemaker system removals in octogenarians

doi: 10.11909/j.issn.1671-5411.2021.07.006

1.
Department of Cardiology, Tokyo Women’s Medical University, Kawada-cho, Shinjuku-ku 8-1, Tokyo 162-8666, Japan
2.
Department of Cardiovascular Medicine, Shinshu University, School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
3.
Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo 162-8666, Japan

^*The authors contributed equally to this manuscript

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Corresponding author: shoda.morio@twmu.ac.jp
Publish Date: 2021-07-28

Abstract

Abstract

Background Management of pacemaker (PM) infections among advanced aged patients possesses particular clinical challenges due to higher rates of concurrent cardiovascular disease and medical comorbidities. Novel leadless cardiac pacemakers (LCPs) may provide new opportunities for better management options in this population, however, there is limited data especially in Asian populations to guide the decision making. Methods We reviewed 11 octogenarians (median age: 86 [minimum 82–maximum 90] years; male: 73%; median body mass index (BMI): 20.1 kg/m²) who received Micra Transcatheter Pacing System (Medtronic Inc, Minneapolis, MN) implantations following transvenous lead extractions (TLEs) for PM infections. Results All patients had more than two medical comorbidities (average 3.7 comorbidities). The indications for LCP implantations were atrioventricular block in four patients, atrial fibrillation bradycardia in five, and sinus node dysfunction in two. Eight patients (73%) were bridged with temporary pacing using active fixation leads (median interval of 14.0 days), while one with severe dementia underwent a concomitant LCP implantation and TLE during the same procedure. Successful TLEs and LCP implantations were successfully accomplished in all without any complications. The median time from the TLE procedure to discharge was 22 days (minimum 7–maximum 136). All patients remained free of infections during a mean follow-up period of 17.2 ± 6.5 months. Conclusions LCP implantations were safe and effective after removing the entire infectious PM system in all octogenarians. The novel LCP technology may offer an alternative option for considering a re-implantation strategy after transvenous PM infections in elderly patients, particularly those with severe frailty and PM dependency.

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References(25)

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