Somani Riyaz, Daniels James, Mechulan Alexis, Paul Vincent, Sharman David, Sze Shirley, Prat Xavier Viñolas
Glenfield Hospital, University Hospitals of Leicester NHS Trust, UK.
Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
Int J Cardiol Heart Vasc. 2025 Mar 18;58:101649. doi: 10.1016/j.ijcha.2025.101649. eCollection 2025 Jun.
Leadless pacemaker (LPs) is a safe and effective alternative to conventional transvenous pacing. There is currently no guidance on which patients could be safely discharged the same day post-procedure.
To provide guidance to medical teams regarding safe same day discharge (SDD) after LP implantation.
An Advisory Board (AB) of 6 expert Micra™ implanters was formed. Interviews were conducted with each member to understand their experience on patient selection, care pathway, complications, and follow-up of Micra™ implanted patients. This information was used to develop a patient pathway for safe SDD after Micra™ implantation. A further survey was conducted to obtain consensus regarding decision points within the pathway.
The SDD after Micra™ Implantation Patient Pathway consists of four phases:Pre-procedure assessment: Social factors are key in deciding suitability of SDD (6/6 AB members agreed, 100%). Patient's comorbidities, frailty status and timing of procedure are also important in decision-making for SDD.Micra™ implant: Ultrasound-guidance reduces vascular access-related complications, increasing the likelihood for SDD (100%).Post-procedure observation: Peri-procedural complications such as pericardial effusion, severe vascular complications, bleeding from access site and device complications would prevent SDD (100%). Patients should complete 6 h of observation prior to discharge (100%).Follow-up: First follow-up should be in-person, 1-4 weeks post-procedure (84 %). Long-term follow-up should be organised as per Micra™ standard of care at each centre (100 %).
SDD after Micra™ Implantation Patient Pathway was developed via expert consensus. Adoption of the pathway in clinical practice may facilitate safe SDD after Micra™ Implantation.
无导线起搏器（LPs）是传统经静脉起搏的一种安全有效的替代方案。目前对于哪些患者术后可安全当日出院尚无指导意见。
为医疗团队提供关于无导线起搏器植入术后安全当日出院（SDD）的指导意见。
组建了一个由6位Micra™植入专家组成的咨询委员会（AB）。对每位成员进行访谈，以了解他们在Micra™植入患者的患者选择、护理流程、并发症及随访方面的经验。这些信息被用于制定Micra™植入术后安全当日出院的患者流程。进一步开展调查以就该流程中的决策点达成共识。
Micra™植入术后当日出院患者流程包括四个阶段：术前评估：社会因素是决定当日出院适宜性的关键（6/6，即100%的咨询委员会成员认同）。患者的合并症、虚弱状态及手术时间在当日出院决策中也很重要。Micra™植入：超声引导可减少血管通路相关并发症，增加当日出院的可能性（100%）。术后观察：围手术期并发症，如心包积液、严重血管并发症、穿刺部位出血及器械并发症会妨碍当日出院（100%）。患者出院前应完成6小时的观察（100%）。随访：首次随访应为术后1 - 4周的门诊随访（84%）。各中心应按照Micra™的标准护理安排长期随访（100%）。
Micra™植入术后当日出院患者流程是通过专家共识制定的。在临床实践中采用该流程可能有助于Micra™植入术后的安全当日出院。
