Kiblboeck Daniel, Blessberger Hermann, Ebner Jakob, Boetscher Jakob, Maier Julian, Reiter Christian, Kellermair Joerg, Steinwender Clemens, Saleh Karim
Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Krankenhausstr. 9, 4020, Linz, Austria.
Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria.
Clin Res Cardiol. 2024 Aug 12. doi: 10.1007/s00392-024-02516-0.
Patients requiring extraction of infected or dysfunctional cardiac implantable electronic devices (CIED) have high morbidity and mortality. The Micra™ leadless cardiac pacemaker (LCP) may be beneficial for patients requiring permanent pacemaker therapy after CIED extraction.
This study aimed to assess the feasibility, timing and outcomes of LCP implantation in patients who underwent CIED extraction due to infection or dysfunction. The local Micra™ LCP registry was reviewed for LCP implantations and CIED extractions.
Micra™ LCP implantation was scheduled for 48 consecutive patients (21 women, 44%) undergoing CIED extraction for infection (n = 38, 79%) or dysfunction (n = 10, 21%), and feasible in 47 (98%). Complete CIED removal was feasible in 44 patients (92%) and in 37/38 patients with infected CIED (97%). Overall, 32 LCP (67%) were implanted in a single procedure: 3 (6%) before and 13 (27%) after CIED extraction. LCP were implanted in a single procedure in 24/38 patients (63%) with infected CIED and in 8/10 patients (80%) with dysfunctional CIED. The in-hospital mortality rate was 6% (n = 3), and the survival rates at 30 days, 90 days and 1 year were 94% (n = 45/48), 90% (n = 43/48), and 85% (n = 41/48), respectively. No recurrent LCP-related mortality or infections occurred during a median follow-up of 15 (interquartile range, 12-41) months.
Two-thirds of LCPs could be implanted in a single procedure with CIED extraction; no recurrent infections were detected. Overall, Micra™ LCP implantation in patients requiring CIED extraction was feasible.
需要取出感染或功能失调的心脏植入式电子设备（CIED）的患者具有较高的发病率和死亡率。Micra™无导线心脏起搏器（LCP）可能对CIED取出后需要永久起搏器治疗的患者有益。
本研究旨在评估因感染或功能失调而接受CIED取出的患者植入LCP的可行性、时机和结果。回顾了当地Micra™ LCP登记处关于LCP植入和CIED取出的情况。
连续48例（21例女性，44%）因感染（n = 38，79%）或功能失调（n = 10, 21%）而接受CIED取出手术的患者计划植入Micra™ LCP，其中47例（98%）可行。44例患者（92%）能够完全取出CIED，38例感染CIED的患者中有37例（97%）能够完全取出。总体而言，32例LCP（67%）在单次手术中植入：CIED取出前植入3例（6%），取出后植入13例（27%）。38例感染CIED的患者中有24例（63%）、10例功能失调CIED的患者中有8例（80%）在单次手术中植入LCP。住院死亡率为6%（n = 3），30天、90天和1年生存率分别为94%（n = 45/48）、90%（n = 43/48）和85%（n = 41/48）。在中位随访15（四分位间距，12 - 41）个月期间，未发生与LCP相关的复发性死亡或感染事件。
三分之二的LCP可在取出CIED的单次手术中植入；未检测到复发性感染。总体而言，在需要取出CIED的患者中植入Micra™ LCP是可行的。
