Department of Cardiology, University Hospital of Tours, Tours, France.
Department of Cardiology, Hospital Center of Orléans, Orléans, France.
J Cardiovasc Electrophysiol. 2023 Aug;34(8):1730-1737. doi: 10.1111/jce.15981. Epub 2023 Jun 24.
The efficacy and safety of leadless cardiac pacemakers (LPMs) as an alternative to conventional transvenous cardiac pacing have been largely reported. The first generation of the Micra transcatheter pacing system (VR; Medtronic) was able to provide single-chamber VVI(R) pacing mode only, with a potential risk of pacemaker syndrome in sinus rhythm patients. A second-generation system (AV) now provides atrioventricular synchrony through atrial mechanical (Am) sensing capability (VDD mode).
We sought to compare VR and AV systems in sinus rhythm patients with chronic ventricular pacing (Vp) for complete atrioventricular block.
All consecutive patients implanted with an LPM in our department for complete atrioventricular block were retrospectively screened. Patients with atrial fibrillation, sinus dysfunction, or Vp burden <20% at 1 month postimplantation were excluded. Patients were systematically followed with a visit at 1 month, and then at least once a year.
A total of 93 patients-45 VR (2015-2020) and 48 AV (2020-2021)-were included. VR and AV patients had similar baseline characteristics, except for VR patients being older (80 ± 8 vs. 77 ± 9 years, p = 0.049). The mean Vp burden was 77% in the VR and 82% in the AV group (p = 0.38). In AV patients, the median AV synchronous beats rate was 78%, with 65% having a >66% rate. An E/A ratio <1.2 as measured on echocardiography was the only independent predictor of accurate atrial mechanical tracking (p = 0.01). One-year survival rate was similar in both groups. Five patients in the VR and 0 in the AV group eventually developed pacemaker syndrome within 1 year post-implantation (p = 0.02).
In sinus rhythm patients with chronic Vp for complete atrioventricular block implanted with an LPM, the atrial mechanical sensing algorithm allowed significant atrioventricular synchrony in most patients and was associated with no occurrence of-otherwise rare-pacemaker syndrome.
无导线心脏起搏器（LPM）作为传统经静脉心脏起搏的替代方法，其疗效和安全性已得到广泛报道。第一代 Micra 经导管起搏系统（VR；美敦力）只能提供单腔 VVI(R)起搏模式，窦性节律患者存在起搏器综合征的潜在风险。第二代系统（AV）现在通过心房机械（Am）感应能力（VDD 模式）提供房室同步。
我们旨在比较窦性节律患者中 VR 和 AV 系统在慢性心室起搏（Vp）治疗完全性房室传导阻滞中的应用。
我们回顾性筛选了在我院植入 LPM 治疗完全性房室传导阻滞的所有连续患者。排除心房颤动、窦性功能障碍或植入后 1 个月时 Vp 负荷<20%的患者。患者系统随访，1 个月随访一次，然后每年随访一次。
共纳入 93 例患者，其中 45 例为 VR（2015-2020 年），48 例为 AV（2020-2021 年）。VR 和 AV 患者的基线特征相似，但 VR 患者年龄较大（80±8 岁 vs. 77±9 岁，p=0.049）。VR 组和 AV 组的平均 Vp 负荷分别为 77%和 82%（p=0.38）。在 AV 患者中，中位房室同步搏动率为 78%，其中 65%的搏动率>66%。超声心动图上测量的 E/A 比值<1.2 是准确心房机械跟踪的唯一独立预测因素（p=0.01）。两组患者的 1 年生存率相似。在植入后 1 年内，VR 组有 5 例患者最终发生起搏器综合征，而 AV 组无患者发生（p=0.02）。
在植入 LPM 的窦性节律患者中，慢性 Vp 治疗完全性房室传导阻滞，心房机械感知算法可使大多数患者获得显著的房室同步，且不发生罕见的起搏器综合征。
