Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Cardiology, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, 611137, China.
J Cardiothorac Surg. 2024 Jul 13;19(1):443. doi: 10.1186/s13019-024-02962-x.
Lead dislodgements, tricuspid valve failure, and wound infections are prominent issues addressed by leadless pacemakers (LPM). These devises have emerged as viable alternatives to conventional transvenous pacemakers. LPMs offer minimized complications and effective pacing, particularly beneficial for elderly patients with a low body mass index (BMI) who are at heightened infection of risk. The Micra AV leadless pacemaker was released in the US in 2020, featuring a VDD pacing mode akin to conventional pacemakers. It senses atrial activity to pace ventricular beats while maintaining the natural atrioventricular activation sequence. Micra AV achieves atrioventricular synchronization through mechanical sensing principles. Ongoing research aims to assess its efficacy, implantation feasibility, and clinical safety.
An 83-year-old man with a history of syncope was the focus of this case study. An implantable cardiac monitor (ICM) recorded occasional high-degree atrioventricular block in the patient. Subsequently, the Micra AV was implanted via the left femoral vein, and its settings were adjusted in accordance with data obtained from the ICM. No significant issues regarding pacing threshold or impedance were found during the follow-up examinations post-surgery. Importantly, the patient experienced a noticeable reduction in symptoms compared to before the implantation.
This case underscores the significance of ICM monitoring in elucidating cardiac events leading to syncope and guiding appropriate treatment. It also highlights the successful outcomes and reliable implantation of the Micra AV for managing high-degree atrioventricular block. This study contributes to the growing body of evidence supporting the adoption of leadless pacemakers as a viable option for patients requiring cardiac pacing, particularly those vulnerable to complications associated with traditional pacemakers. It provides real-world evidence of Micra AV's efficacy and safety, further validating its role in clinical practice.
无导线起搏器（LPM）主要解决了导线脱位、三尖瓣功能障碍和伤口感染等问题。这些设备已成为传统经静脉起搏器的可行替代品。LPM 可减少并发症并实现有效的起搏，特别适用于身体质量指数（BMI）较低的老年患者，这些患者感染风险较高。2020 年，美国推出了 Micra AV 无导线起搏器，采用类似于传统起搏器的 VDD 起搏模式。它通过机械感知原理感知心房活动，以起搏心室搏动，同时保持自然的房室激活顺序。Micra AV 通过机械感知原理实现房室同步。目前正在进行研究，以评估其疗效、植入可行性和临床安全性。
本病例研究的对象是一位 83 岁的晕厥史男性患者。植入式心脏监测器（ICM）记录到患者偶尔出现高度房室传导阻滞。随后，通过左股静脉植入 Micra AV，并根据 ICM 获得的数据调整其设置。术后随访检查未发现起搏阈值或阻抗有明显问题。重要的是，与植入前相比，患者的症状明显减轻。
本病例强调了 ICM 监测在阐明导致晕厥的心脏事件并指导适当治疗方面的重要性。它还突出了 Micra AV 成功的植入结果和可靠的性能，可用于治疗高度房室传导阻滞。该研究为越来越多的证据提供了支持，证明无导线起搏器是需要心脏起搏的患者的可行选择，特别是那些易受传统起搏器相关并发症影响的患者。它提供了 Micra AV 的疗效和安全性的真实世界证据，进一步验证了其在临床实践中的作用。
