Anatomical location of leadless pacemaker and the risk of pacing‐induced cardiomyopathy

Author:

Shantha Ghanshyam1ORCID,Brock Jonathan1,Singleton Matthew2,Kozak Patrick1,Bodziock George1,Bradford Natalie1,Deshmukh Abhishek3ORCID,Liang Jackson J.4,Pothineni Naga Venkata K.5,Hranitzky Patrick6,Whalen Patrick1,Bhave Prashant D.1ORCID

Affiliation:

1. Department of Cardiac Electrophysiology Wake Forest University Winston‐Salem North Carolina USA

2. Wellspan Hospital York Pennsylvania USA

3. Department of Cardiac Electrophysiology Mayo Clinic Rochester Minnesota USA

4. Department of Cardiac Electrophysiology University of Michigan Ann Arbor Michigan USA

5. Kansas City Heart Rhythm Institute Kansas City Missouri USA

6. Department of Cardiac University of North Carolina Chapel Hill North Carolina USA

Abstract

AbstractBackgroundIt is unclear if the location of implantation of the leadless pacemaker (LP) makes a difference in the incidence of pacing‐induced cardiomyopathy (PICM).AimThe aim of this study was to compare the incidence of PICM based on the location of implantation of LP.MethodsA total of 358 consecutive patients [women: 171 (48%), mean age: 73 ± 15 years] with left ventricular ejection fraction (EF) > 50%, who received an LP (Micra) between January 2017 and June 2022, formed the study cohort. Micra‐AV and Micra‐VR were implanted in 122 (34%) and 236 (66%) patients, respectively. Fluoroscopically, the location of implantation of LP in the interventricular septum (IS) was divided into two equal halves (apex/apical septum [AS] and mid/high septum [HS]). During follow‐up, PICM was defined as an EF drop of ≥10%.ResultsLP was implanted in 109 (34%) and 249 (66%) patients at AS and HS locations, respectively. During a mean 18 ± 8 months follow‐up, 28 patients (7.8%) developed PICM. Among the 249 patients with HS placement of LP, 10 (4%) developed PICM, whereas among the 109 patients with AS placement of LP, 18 (16.5%) developed PICM (p = .002). AS location was associated with a higher risk of PICM compared to HS locations (adjusted hazard ratio: 4.42, p < .001).ConclusionAS location of LP was associated with a higher risk of PICM compared to HS placement. Larger randomized studies are needed to confirm our findings.

Publisher

Wiley

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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