Patient selection, pacing indications, and subsequent outcomes with de novo leadless single-chamber VVI pacing

Piccini JP 1 , Stromberg K 2 , Jackson KP 1 , Kowal RC 2 , Duray GZ 3 , El-Chami MF 4 Show all authors , Crossley GH 5 , Hummel JD 6 , Narasimhan C 7 , Omar R 8 , Ritter P 9 , Roberts PR 10 , Soejima K 11 , Reynolds D 12 , Zhang S 13 , Steinwender C 14 , Chinitz L 15 , Micra Transcatheter Pacing Study Group

Affiliations 

  • 1 Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
  • 2 Medtronic plc, Mounds View, MN, USA
  • 3 Clinical Electrophysiology Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
  • 4 Emory University Hospital, Atlanta, GA, USA
  • 5 Vanderbilt University Medical Center, Nashville, TN, USA
  • 6 Ohio State University, Columbus, OH, USA
  • 7 CARE Hospitals and CARE Foundation, Hyderabad, India
  • 8 Electrophysiology and Pacing Unit, National Heart Institute, Kuala Lumpur, Malaysia
  • 9 Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
  • 10 University Hospital Southampton, Southampton, UK
  • 11 Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
  • 12 Cardiovascular Section, University of Oklahoma Health Sciences Center, OU Medical Center, Oklahoma City, OK, USA
  • 13 Fuwai Hospital, Beijing, China
  • 14 Kepler University Hospital, Linz, Austria
  • 15 New York University, New York, NY, USA
Europace, 2019 Nov 01;21(11):1686-1693.
PMID: 31681964 DOI: 10.1093/europace/euz230

Abstract

AIMS: Patient selection is a key component of securing optimal patient outcomes with leadless pacing. We sought to describe and compare patient characteristics and outcomes of Micra patients with and without a primary pacing indication associated with atrial fibrillation (AF) in the Micra IDE trial.

METHODS AND RESULTS: The primary outcome (risk of cardiac failure, pacemaker syndrome, or syncope related to the Micra system or procedure) was compared between successfully implanted patients from the Micra IDE trial with a primary pacing indication associated with AF or history of AF (AF group) and those without (non-AF group). Among 720 patients successfully implanted with Micra, 228 (31.7%) were in the non-AF group. Reasons for selecting VVI pacing in non-AF patients included an expectation for infrequent pacing (66.2%) and advanced age (27.2%). More patients in the non-AF group had a condition that precluded the use of a transvenous pacemaker (9.6% vs. 4.7%, P = 0.013). Atrial fibrillation patients programmed to VVI received significantly more ventricular pacing compared to non-AF patients (median 67.8% vs. 12.6%; P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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