Leadless pacemaker implant in patients with pre-existing infections: Results from the Micra postapproval registry

• Type of Material: Article
• Authors: Mikhael El Chami, Emory University; Jens Brock Johansen, Odense University Hospital; Amir Zaidi, NHS Foundation Trust; Svein Faerestrand, Haukeland Hospital; Dwight Reynolds, University of Bergen; Javier Garcia-Seara, University Clinical Hospital of Santiago de Compostela; Jacques Mansourati, CHU de Brest; Jean-Luc Pasquie, University of Montpellier; Hugh Thomas McElderry, University of Alabama Birmingham; Paul R. Roberts, University Hospital Southampton; Kyoko Soejima, Kyorin University Hospital; Kurt Stromberg, Medtronic, Plc; Jonathan P. Piccini, Duke University
• Language: English
• Date: 2019-04-01
• Publisher: Wiley: 12 months
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. Journal of Cardiovascular Electrophysiology Published by Wiley Periodicals, Inc.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/jce.13851
• Title of Journal or Parent Work: Journal of Cardiovascular Electrophysiology
• ISSN: 1045-3873
• Volume: 30
• Issue: 4
• Start Page: 569
• End Page: 574
• Grant/Funding Information: The Micra Transcatheter Pacing System Post‐Approval Registry is funded by Medtronic, plc.
• Keywords: Micra; Science & Technology; MORTALITY; RATES; Cardiovascular System & Cardiology; leadless pacemakers; Cardiac & Cardiovascular Systems; DEVICE INFECTIONS; Life Sciences & Biomedicine; transcatheter pacemaker; EXTRACTION; cardiac implantable electronic device infection; permanent pacing
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Introduction: Leadless pacemakers may provide a safe and attractive pacing option to patients with cardiac implantable electronic device (CIED) infection. We describe the characteristics and outcomes of patients with a recent CIED infection undergoing Micra implant attempt. Methods and Results: Patients with prior CIED infection and device explant with Micra implant within 30 days, were identified from the Micra post approval registry. Procedure characteristics and outcomes were summarized. A total of 105 patients with prior CIED infection underwent Micra implant attempt ≤30 days from prior system explant (84 [80%] pacemakers and 13 [12%] ICD/CRT-D). All system components were explanted in 93% of patients and explant occurred a median of 6 days before Micra implant, with 37% occurring on the day of Micra implant. Micra was successfully implanted in 99% patients, mean follow-up duration was 8.5 ± 7.1 months (range 0-28.5). The majority of patients (91%) received IV antibiotics preimplant, while 42% of patients received IV antibiotics postprocedure. The median length of hospitalization following Micra implant was 2 days (IQR, 1-7). During follow-up, two patients died from sepsis and four patients required system upgrade, of which two patients received Micra to provide temporary pacing support. There were no Micra devices explanted due to infection. Conclusion: Implantation of the Micra transcatheter pacemaker is safe and feasible in patients with a recent CIED infection. No recurrent infections that required Micra device removal were seen. Leadless pacemakers appear to be a safe pacing alternative for patients with CIED infection who undergo extraction.