Yuma Regional Medical Center showcases a promising alternative to conventional pacemakers

In the quest to overcome the hurdles associated with aortic valve disease, transcatheter aortic valve replacement (TAVR) has risen as a significant stride in medical advancements. This minimally invasive surgical procedure has been transformative for patients suffering from severe aortic valve stenosis. Nonetheless, this breakthrough is not without its challenges. Post-procedural conduction disturbances have often necessitated the implantation of permanent pacemakers, marking a critical juncture in the treatment paradigm.

Traditionally, conventional transvenous pacemakers have shouldered the responsibility of managing these complications. However, the landscape of post-TAVR care is undergoing a seismic shift. Yuma Regional Medical Center has been at the forefront of this change with the introduction of the MICRA Transcatheter Pacing System (TPS), a state-of-the-art leadless pacemaker that is setting a new standard in patient care.

The cutting-edge study undertaken by the experts at the center delves into the practicality and efficiency of these leadless pacemakers. Published in the esteemed journal Cardiovascular Revascularization Medicine, the research shines a light on this innovative treatment option with an emphasis on procedural safety and long-term patient outcomes (DOI: 10.1016/j.carrev.2024.01.005).

The retrospective, single-center study, meticulously conducted by cardiologists Kameel Kassab, Jagat Patel, Habteab Feseha, and Evren Kaynak, scrutinized the clinical profiles and procedural specifics of all patients undergoing TAVR at the facility. The focus remained strictly on cases where MICRA AV, a variety of leadless pacemakers, was implanted within 30 days following the valve replacement procedure.

Out of the cases reviewed, nine patients were identified who had undergone the revolutionary MICRA AV implantation. The patients, characterized by an average age of 79.6 years and a median STS (Society of Thoracic Surgeons) score of 3.7%, mainly received balloon-expandable valves. The noteworthy findings indicate a smooth procedural experience, as none of the patients reported complications during the pacemaker implantation.

The study’s narrative doesn’t end at the procedural success; it stretches into the realm of post-procedural care, where consistent follow-up spanning an average of 353 days reveals telling insights into the device’s performance. The follow-up data underlines the stability of capture thresholds and lead impedance with an average RV pacing percentage standing at 13%.

Overall, the small cohort serves as a testament to the viability and safety of MICRA AV leadless pacemakers in the aftermath of TAVR. More crucially, it establishes leadless pacemakers as devices capable of preserving AV synchrony, which is pivotal in ensuring the heart beats efficiently.

As we absorb the implications of these findings, it is essential to recognize the broader impacts. The practicality of leadless pacemakers is not merely confined to their immediate success rates but extends to their potential to alter post-surgical care dynamics. Patients and healthcare providers may soon lean towards leadless devices as a preferred option, giving way to a new standard in managing TAVR-associated cardiac disturbances.

Emerging data, such as that from the Yuma Regional Medical Center, reinforces the significance of continuous innovation in cardiovascular therapies. As medical technology evolves, so must our clinical practices, always with the singular goal of enhancing patient care and outcomes.

The pioneering study advocates for the further investigation of leadless cardiac pacemakers. With larger, multicenter studies, the medical community could more firmly establish their role in TAVR post-operative care. Potentially, in the not-too-distant future, it is conceivable that the frequency of these advanced devices could outpace that of their conventional counterparts.

Copyright © 2024 Elsevier Inc. All rights reserved.

Keywords

1. Leadless Pacemaker TAVR
2. MICRA AV Implantation
3. Post-TAVR Pacemaker Complications
4. Minimally Invasive Valve Replacement
5. Cardiac Pacing Innovations

References

Kameel Kassab et al., (2024), “MICRA AV implantation after transcatheter aortic valve replacement”, Cardiovascular revascularization medicine : including molecular interventions; DOI: 10.1016/j.carrev.2024.01.005.

Smith, C. R., Leon, M. B., Mack, M. J., et al. (2011). Transcatheter versus surgical aortic-valve replacement in high-risk patients. The New England Journal of Medicine, 364(23), 2187-2198.

Reardon, M. J., Van Mieghem, N. M., Popma, J. J., et al. (2017). Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. The New England Journal of Medicine, 376(14), 1321-1331.

Reddy, V. Y., Exner, D. V., Cantillon, D. J., et al. (2015). Percutaneous Implantation of an Entirely Intracardiac Leadless Pacemaker. The New England Journal of Medicine, 373(12), 1125-1135.

Søndergaard, L., Steinbrüchel, D. A., Ihlemann, N., et al. (2015). Two-Year Outcomes in Patients Treated With Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis in High-Risk and Inoperable Patients With Decreased Left Ventricular Function: Results From the CoreValve High Risk Study. Circulation, 132(6), 434-443.

Holmes, D. R., Nishimura, R. A., Grover, F. L., et al. (2015). Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry. Journal of the American College of Cardiology, 66(22), 2813-2823.