Kroman Anne, Saour Basil, Prutkin Jordan M
Division of Cardiology, Section of Electrophysiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
Curr Treat Options Cardiovasc Med. 2019 Sep 5;21(10):54. doi: 10.1007/s11936-019-0763-y.
Leadless pacemakers were developed to reduce complications associated with transvenous pacemaker implant and long-term follow-up. Since initial market release, however, there have been registry and single-center reports documenting improvements in implant technique, reduced complication rates, and new patient populations studied.
Most studies have demonstrated a further reduction in complication rates and safe implant in those on continuous anticoagulation. Perforation rates are decreasing but still occur and risk factors include BMI < 20 kg/m2, age ≥ 85 years, females, history of heart failure, indication not including atrial fibrillation, and chronic lung disease. Device infections are exceedingly rare, even in those undergoing infected transvenous devices at the same time. For appropriate patients, leadless pacing is a safe and reasonable option, especially if atrial-based sensing or pacing is not needed. Future iterations may include VDD pacing, atrial pacing, dual-chamber pacing, biventricular pacing, and device-device communication.
无导线起搏器的研发旨在减少与经静脉起搏器植入及长期随访相关的并发症。然而，自首次投放市场以来，已有注册研究和单中心报告记录了植入技术的改进、并发症发生率的降低以及新的研究患者群体。
大多数研究表明，持续抗凝患者的并发症发生率进一步降低，且植入安全。穿孔率在下降，但仍有发生，危险因素包括体重指数（BMI）<20kg/m²、年龄≥85岁、女性、心力衰竭病史、非房颤适应证以及慢性肺病。器械感染极为罕见，即使是同时接受感染性经静脉器械的患者。对于合适的患者，无导线起搏是一种安全合理的选择，尤其是在不需要基于心房的感知或起搏时。未来的迭代可能包括VDD起搏、心房起搏、双腔起搏、双心室起搏以及器械间通信。
