Jaroonpipatkul Surachat, Sutheerapatranont Sutham, Navaravong Leenhapong, Pokawattana Apichai
Division of Cardiology, Rajavithi Hospital, College of Medicine Rangsit University, Bangkok, Thailand.
Division of Cardiology, Rajavithi Hospital, College of Medicine Rangsit University, Bangkok, Thailand.
Indian Pacing Electrophysiol J. 2025 Jan-Feb;25(1):20-24. doi: 10.1016/j.ipej.2024.12.002. Epub 2024 Dec 30.
The advancement of medical technology has introduced leadless pacemakers (LPMs) as a significant innovation in cardiac pacing, offering potential advantages over traditional ventricular transvenous pacemakers. This report explores the application of LPMs in two patients with complex valvular histories, particularly those with mechanical tricuspid valves.
The first case involves a 60-year-old male with a history of rheumatic heart disease and triple valve replacement who developed a high-grade AV block. Due to significant RV pacing, a single-chamber VVI pacemaker using the Micra Transcatheter Pacing System was successfully implanted, navigating the mechanical tricuspid valve with stable pacing parameters. The second case describes a 70-year-old female with HIV, diabetes, hypothyroidism, and multiple valve surgeries presenting with syncope and dyspnea. Given her complex medical history and recurrent conduction issues, the Micra pacemaker was chosen. Despite initial resistance, successful deployment was achieved at the lower septum with acceptable pacing thresholds.
LPMs offer a promising alternative for patients with mechanical tricuspid valves, eliminating the risks associated with transvenous leads. The Micra system's minimally invasive approach and stable performance in these challenging cases suggest its potential viability in high-risk patients with complex valvular conditions.
These cases demonstrate the feasibility of LPM implantation through mechanical tricuspid valves; however, given the associated risks, careful evaluation and meticulous procedural planning are essential before considering this approach.
医学技术的进步引入了无导线起搏器（LPM），这是心脏起搏领域的一项重大创新，与传统的心室经静脉起搏器相比具有潜在优势。本报告探讨了LPM在两名有复杂瓣膜病史患者中的应用，特别是那些植入了机械性三尖瓣的患者。
首例病例为一名60岁男性，有风湿性心脏病和三尖瓣置换史，发生了高度房室传导阻滞。由于右心室起搏显著，使用Micra经导管起搏系统成功植入了单腔VVI起搏器，在机械性三尖瓣的情况下获得了稳定的起搏参数。第二例病例描述了一名70岁女性，患有艾滋病毒、糖尿病、甲状腺功能减退症且接受过多次瓣膜手术，出现晕厥和呼吸困难。鉴于其复杂的病史和反复出现的传导问题，选择了Micra起搏器。尽管最初遇到阻力，但在较低的间隔处成功植入，起搏阈值可接受。
LPM为植入机械性三尖瓣的患者提供了一种有前景的替代方案，消除了与经静脉导线相关的风险。Micra系统的微创方法及其在这些具有挑战性病例中的稳定性能表明，其在患有复杂瓣膜疾病的高危患者中具有潜在的可行性。
这些病例证明了通过机械性三尖瓣植入LPM的可行性；然而，鉴于相关风险，在考虑这种方法之前，仔细评估和精心的手术规划至关重要。
