Mizukami Akira, Miyakuni Shota, Nakada Ryo, Kobayashi Tetsuya, Kawakami Takuya, Takegawa Koki, Arai Hirofumi, Hiroki Jiro, Yoshioka Kenji, Otani Hirofumi, Ono Maki, Yamashita Shu, Ueshima Daisuke, Suzuki Makoto, Matsumura Akihiko, Goya Masahiko, Sasano Tetsuo
Department of Cardiology Kameda Medical Center Chiba Japan.
Department of Cardiology Yokohama City Minato Red Cross Hospital Yokohama Japan.
J Arrhythm. 2022 Nov 23;39(1):10-17. doi: 10.1002/joa3.12797. eCollection 2023 Feb.
Micra leadless pacemaker is secured to the myocardium by engagement of at least 2/4 tines confirmed with pull and hold test. However, the pull and hold test is sometimes difficult to assess. This study was performed to evaluate whether the angle of the tines before the pull and hold test predicts engagement of the tines in Micra leadless pacemaker implantation.
We retrospectively enrolled 93 consecutive patients (52.7% male, age 82.4 ± 9.4 years), who received Micra implantation from September 2017 to June 2020 at our institution. After deployment and before the pull and hold test, the angle of the visible tines to the body of the pacemaker was measured using the RAO view of the fluoroscopy image. The engagement of the tines was then confirmed with the pull and hold test.
A total of 326 tines were analyzed. The angle of the engaged tines was significantly lower than the non-engaged tines (9.2 degrees [4.0-14.0] vs. 16.6 degrees [14.2-18.8], < .0001). All tines with angles <10 degrees were engaged. In higher angles, engagement could not be predicted.
A low angle of the tines before the pull and hold test can predict engagement of the tines in Micra leadless pacemaker implantation. The tines which are already open after deployment may be presumed that they are engaged.
Micra无导线起搏器通过至少2/4个棘齿与心肌接合来固定，这通过牵拉和保持测试来确认。然而，牵拉和保持测试有时难以评估。本研究旨在评估牵拉和保持测试前棘齿的角度是否能预测Micra无导线起搏器植入时棘齿的接合情况。
我们回顾性纳入了93例连续患者（男性占52.7%，年龄82.4±9.4岁），这些患者于2017年9月至2020年6月在我院接受了Micra植入。在展开后且牵拉和保持测试前，使用荧光透视图像的右前斜位视图测量可见棘齿与起搏器主体的角度。然后通过牵拉和保持测试确认棘齿的接合情况。
共分析了326个棘齿。已接合棘齿的角度显著低于未接合棘齿（9.2度[4.0 - 14.0]对16.6度[14.2 - 18.8]，<0.0001）。所有角度<10度的棘齿均已接合。在角度较高时，无法预测接合情况。
牵拉和保持测试前棘齿角度较低可预测Micra无导线起搏器植入时棘齿的接合情况。展开后已张开的棘齿可能被推测为已接合。
