Scripties UMCG - Rijksuniversiteit Groningen
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Intracardiac dual chamber leadless pacing; which patients benefit the most?

(2018) Dasselaar, K.J.

Background To date, clinically available leadless pacemakers provide ventricular single-chamber (VVI) pacing therapy, which eliminates lead- and device related complications associated with transvenous devices. VVI therapy only serves a minor percentage of pacemaker recipients (i.e.<25%). Advanced, communicating, leadless dual chamber (DDD) pacing therapy is expected to become clinically available in the near future. This novel approach will revolutionize the state of pacing therapy and expand its potential benefits to a larger population. However, the potential inability to retrieve chronically implanted DDD leadless pacemakers at end-of-life limits its application.
Objective We sought to evaluate patients who potentially qualify for future leadless DDD-therapy primarily based on the estimated battery longevity.
Methods Patients who underwent a DDD pacemaker implantation between 2010 - 2017 with a minimum follow up of 1 year at the Academic Medical Center (Amsterdam) were included. Patients characteristics, pacemaker parameters (i.e., sensor function, percentage atrial and ventricular pacing, impedance, threshold), complications, implantation data and pacing indication were collected. Results A total of 275 patients were included with a mean follow up of 3.2±1.6 years. Complications occurred in 14.9% of the patients, with the majority (i.e. 12.2%) being lead- and generator related (i.e. dislocation, hematoma). Patients with an AV-block had the earliest battery depletion of their pacemaker system, primarily based on the highest percentage of (ventricular) pacing (mean of 74.2%) . Conclusion This study showed that the lead(s) and pocket of the conventional DDD pacemakers are the Achilles heel of this system. Therefore, leadless DDD devices are a most welcome development in the fields of cardiology. Patients with a sick sinus syndrome are the most eligible patients to receive the novel DDD leadless pacemaker, based on the longest projected estimated battery longevity.

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