Second Department of Cardiology, Cardiothoracic and Vascular Department - University Hospital of Pisa, Via Paradisa, 2, Pisa, Italy.
Europace. 2019 Aug 1;21(8):1229-1236. doi: 10.1093/europace/euz160.
We aimed at investigating the feasibility and outcome of Micra implant in patients who have previously undergone transvenous lead extraction (TLE), in comparison to naïve patients implanted with the same device.
Eighty-three patients (65 males, 78.31%; 77.27 ± 9.96 years) underwent Micra implant at our centre. The entire cohort was divided between 'post-extraction' (Group 1) and naïve patients (Group 2). In 23 of 83 patients (20 males, 86.96%; 73.83 ± 10.29 years), Micra was implanted after TLE. Indication to TLE was an infection in 15 patients (65.21%), leads malfunction in four (17.39%), superior vena cava syndrome in three (13.05%), and severe tricuspid regurgitation in one case (4.35%). The implant procedure was successful in all patients and no device-related events occurred at follow-up (median: 18 months; interquartile range: 1-24). No differences were observed between groups in fluoroscopy time (13.88 ± 10.98 min vs. 13.15 ± 6.64 min, P = 0.45), single device delivery (Group 1 vs. Group 2: 69.56% vs. 55%, P = 0.22), electrical performance at implant and at 12-month follow-up (Group 1 vs. Group 2: pacing threshold 0.48 ± 0.05 V/0.24 ms vs. 0.56 ± 0.25 V/0.24 ms, P = 0.70; impedance 640 ± 148.83 Ohm vs. 583.43 ± 99.7 Ohm, P = 0.27; and R wave amplitude 10.33 ± 2.88 mV vs. 12.62 ± 5.31 mV, P = 0.40). A non-apical site of implant was achievable in the majority of cases (72.3%) without differences among groups (78.26% vs. 70%; P = 0.42).
Micra implant is an effective and safe procedure in patients still requiring a ventricular pacing after TLE, with similar electrical performance and outcome compared with naïve patients at long-term follow-up.
我们旨在研究在先前接受过经静脉导线拔除术（TLE）的患者中植入 Micra 植入物的可行性和结果，并与植入相同设备的初治患者进行比较。
83 名患者（65 名男性，78.31%；77.27±9.96 岁）在我们中心接受了 Micra 植入。整个队列分为“拔除后”（第 1 组）和初治患者（第 2 组）。在 83 名患者中的 23 名（20 名男性，86.96%；73.83±10.29 岁）中，在 TLE 后植入了 Micra。TLE 的适应证为 15 例（65.21%）感染、4 例（17.39%）导线故障、3 例（13.05%）上腔静脉综合征和 1 例（4.35%）严重三尖瓣反流。所有患者的植入手术均成功，随访期间未发生与器械相关的事件（中位数：18 个月；四分位距：1-24 个月）。两组之间透视时间（13.88±10.98 分钟 vs. 13.15±6.64 分钟，P=0.45）、单次器械输送（第 1 组 vs. 第 2 组：69.56% vs. 55%，P=0.22）、植入时和 12 个月随访时的电性能（第 1 组 vs. 第 2 组：起搏阈值 0.48±0.05 V/0.24 毫秒 vs. 0.56±0.25 V/0.24 毫秒，P=0.70；阻抗 640±148.83 欧姆 vs. 583.43±99.7 欧姆，P=0.27；R 波振幅 10.33±2.88 mV vs. 12.62±5.31 mV，P=0.40）均无差异。在大多数情况下（72.3%）可以实现非心尖部位的植入，且两组之间无差异（78.26% vs. 70%；P=0.42）。
在 TLE 后仍需要心室起搏的患者中，植入 Micra 是一种有效且安全的方法，与初治患者相比，长期随访时其电性能和结果相似。
