Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology, Amsterdam UMC Location AMC, Amsterdam, the Netherlands.
JACC Clin Electrophysiol. 2024 Oct;10(10):2224-2233. doi: 10.1016/j.jacep.2024.06.018. Epub 2024 Aug 14.
Intraoperative implantation of leadless cardiac pacemakers (LCPs) under direct visualization during cardiac surgery is a novel strategy to provide pacing to patients with an elevated risk of postoperative conduction disorders or with a preexisting pacing indication undergoing valve surgery.
This study sought to evaluate the long-term safety and efficacy of intraoperative LCP implantation in 100 consecutive patients.
Retrospective single-center cohort study of consecutive patients (n = 100) who underwent intraoperative LCP implantation during valve surgery. Safety and efficacy were assessed at implantation and follow-up visits.
A total of 100 patients (age 68 ± 13 years, 47% female) underwent intraoperative LCP implantation. The surgery involved the tricuspid valve in 99 patients (99%), including tricuspid valve repair in 59 (59%) and tricuspid valve replacement in 40 (40%). Most of the patients (78%) underwent multivalve surgery. The indication for LCP implantation was elevated risk of postoperative atrioventricular block in 54% and preexisting bradyarrhythmias in 46%. LCP implantation was successful in all patients. During a median of 10.6 months (IQR: 2.0-22.7 months) of follow-up, no device-related complications occurred. At 12-month follow-up, the pacing thresholds were acceptable (≤2.0 V at 0.24 milliseconds) in 95% of patients.
Intraoperative LCP implantation under direct visualization is a safe strategy to provide permanent pacing in patients undergoing valve surgery, with a postoperative electrical performance comparable to percutaneously placed LCPs.
在心脏手术期间直视下植入无导线心脏起搏器（LCP）是为术后发生传导障碍风险较高或存在预先存在起搏适应证的瓣膜手术患者提供起搏的新策略。
本研究旨在评估 100 例连续患者术中植入 LCP 的长期安全性和有效性。
回顾性连续单中心队列研究，纳入 100 例行术中 LCP 植入的瓣膜手术患者。在植入和随访时评估安全性和疗效。
共纳入 100 例患者（年龄 68±13 岁，47%为女性）行术中 LCP 植入。99 例（99%）患者行三尖瓣手术，其中 59 例行三尖瓣修复（59%），40 例行三尖瓣置换（40%）。大多数患者（78%）行多瓣膜手术。LCP 植入的适应证为术后发生房室传导阻滞的风险较高（54%）和预先存在的心动过缓（46%）。所有患者均成功植入 LCP。中位随访 10.6 个月（IQR：2.0-22.7 个月）期间，无器械相关并发症发生。12 个月随访时，95%的患者起搏阈值可接受（≤2.0 V 时为 0.24 毫秒）。
直视下植入 LCP 是一种为行瓣膜手术患者提供永久性起搏的安全策略，其术后电性能与经皮植入的 LCP 相当。
