Leadless Pacemaker Implantation in the Emergency Bradyarrhythmia Setting: Results from a Multicenter European Registry.
Marco SchiavoneAnnalisa FiltzAlessio GasperettiAlexander BreitensteinPietro PalmisanoGianfranco MitacchioneSimone GullettaGian Battista ChierchiaElisabetta MontemerloGiovanni StatutoGiulia RussoMichela CasellaFrancesco VitaliPatrizio MazzoneDaniel HoferGianmarco ArabiaFabrizio TundoDiego RuggieroNicolai FierroMassimo MoltrasioMatteo BertiniAntonio Dello RussoEnnio C L PisanòPaolo Della BellaGiovanni RovarisCarlo de AsmundisMauro BiffiAntonio CurnisClaudio TondoArdan M SagunerGiovanni Battista ForleoPublished in: Medicina (Kaunas, Lithuania) (2022)
Background. Data on leadless pacemaker (LPM) implantation in an emergency setting are currently lacking. Objective. We aimed to investigate the feasibility of LPM implantation for emergency bradyarrhythmia, in patients referred for urgent PM implantation, in a large, multicenter, real-world cohort of LPM recipients. Methods. Two cohorts of LPM patients, stratified according to the LPM implantation scenario (patients admitted from the emergency department (ED+) vs. elective patients (ED-)) were retrieved from the iLEAPER registry. The primary outcome of the study was a comparison of the peri-procedural complications between the groups. The rates of peri-procedural characteristics (overall procedural and fluoroscopic duration) were deemed secondary outcomes. Results. A total of 1154 patients were enrolled in this project, with patients implanted due to an urgent bradyarrhythmia (ED+) representing 6.2% of the entire cohort. Slow atrial fibrillation and complete + advanced atrioventricular blocks were more frequent in the ED+ cohort (76.3% for ED+ vs. 49.7% for ED-, p = 0.025; 37.5% vs. 27.3%, p = 0.027, respectively). The overall procedural times were longer in the ED+ cohort (60 (45-80) mins vs. 50 (40-65) mins, p < 0.001), showing higher rates of temporary pacing (94.4% for ED+ vs. 28.9% for ED-, p < 0.001). Emergency LPM implantation was not correlated with an increase in the rate of major complications compared to the control group (6.9% ED+ vs. 4.2% ED-, p = 0.244). Conclusion. LPM implantation is a feasible procedure for the treatment of severe bradyarrhythmia in an urgent setting. Urgent LPM implantation was not correlated with an increase in the rate of major complications compared to the control group, but it was associated with longer procedural times.
Keyphrases
- emergency department
- end stage renal disease
- ejection fraction
- chronic kidney disease
- newly diagnosed
- prognostic factors
- peritoneal dialysis
- public health
- healthcare
- risk assessment
- clinical trial
- risk factors
- type diabetes
- metabolic syndrome
- patients undergoing
- coronary artery disease
- machine learning
- patient reported
- percutaneous coronary intervention
- early onset
- minimally invasive
- heavy metals
- deep learning
- smoking cessation
- air pollution
- pulmonary embolism
- direct oral anticoagulants
- vena cava
- adverse drug
- cardiac resynchronization therapy