Loughlin Gerard, Pachón Marta, Martínez-Sande José Luis, Ibáñez José Luis, Bastante Teresa, Osca Asensi Joaquín, González Melchor Laila, Martínez-Martínez Juan Gabriel, Cuesta Javier, Arias Miguel A
Department of Cardiology, Arrhythmia Unit, Hospital Universitario de Toledo, Toledo, Spain.
Department of Cardiology, Arrhythmia Unit, Hospital Clínico Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, Spain.
J Cardiovasc Electrophysiol. 2022 May;33(5):997-1004. doi: 10.1111/jce.15462. Epub 2022 Apr 2.
Device infections constitute a major complication of transvenous pacemakers. Mechanical heart valves (MHV) increase the risk of infective endocarditis (IE) and pacemaker infection, requiring lifelong vitamin K-antagonists (VKA), which may affect patient management. Leadless pacemakers (LP) are associated with low infection rates, posing an attractive option in MHV patients requiring permanent pacing. This study describes outcomes following LP implantation in patients with MHV.
This is a multicenter, observational, retrospective study including consecutive patients implanted with an LP at 5 centers between June 2015 and January 2020. Procedural outcomes, antithrombotic management, complications, performance during follow-up and episodes of bacteremia and IE were compared between patients with and without an MHV (MHV and non-MHV groups).
Four hundred fifty-nine patients were included (74 in the MHV group, 16.1%, and 385 in the non-MHV group, 83.9%). Procedural outcomes and acute electrical performance were comparable between groups. Vascular complications and cardiac perforation occurred in 2.7 versus 2.3% (p = 1) and 0% versus 0.8% (p = 1) in the MHV group and non-MHV group. One case of IE occurred in the MHV group and 2 in the non-MHV group. In MHV patients, uninterrupted VKA was used in 83.8%, whereas 16.2% were heparin-bridged. Vascular complication or tamponade occurred in 1 (8.3%) MHV heparin-bridged patient versus 1 (1.6%) MHV uninterrupted VKA patient (p = .3).
LP implantation outcomes in MHV patients are comparable to the general LP population. Device-related infections are rare following LP implantation, including in patients with MHV. In the MHV group, periprocedural anticoagulation management was not associated with significantly different rates of tamponade or vascular complication.
器械感染是经静脉起搏器的主要并发症。机械心脏瓣膜（MHV）会增加感染性心内膜炎（IE）和起搏器感染的风险，需要终身使用维生素K拮抗剂（VKA），这可能会影响患者的管理。无导线起搏器（LP）的感染率较低，对于需要永久起搏的MHV患者是一个有吸引力的选择。本研究描述了MHV患者植入LP后的结果。
这是一项多中心、观察性、回顾性研究，纳入了2015年6月至2020年1月期间在5个中心连续植入LP的患者。比较了有和没有MHV的患者（MHV组和非MHV组）的手术结果、抗栓管理、并发症、随访期间的性能以及菌血症和IE发作情况。
共纳入459例患者（MHV组74例，占16.1%；非MHV组385例，占83.9%）。两组的手术结果和急性电学性能相当。MHV组和非MHV组的血管并发症发生率分别为2.7%和2.3%（p = 1），心脏穿孔发生率分别为0%和0.8%（p = 1）。MHV组发生1例IE，非MHV组发生2例。在MHV患者中，83.8%使用不间断VKA，16.2%采用肝素桥接。1例（8.3%）采用肝素桥接的MHV患者发生血管并发症或心包填塞，1例（1.6%）使用不间断VKA的MHV患者发生该情况（p = 0.3）。
MHV患者植入LP的结果与一般LP人群相当。LP植入后与器械相关的感染很少见，包括MHV患者。在MHV组中，围手术期抗凝管理与心包填塞或血管并发症的发生率无显著差异。
