Micra AV leadless pacemaker implantation after transcatheter aortic valve implantation

Abstract

Abstract Background Transvenous pacemaker (PM) implantation is a complication in patients undergoing transcatheter aortic valve implantation (TAVI). Recently, a second generation of leadless PMs able of atrioventricular (AV) synchronous pacing has been introduced and could be an alternative when ventricular pacing is required after TAVI. Real‐world data on Micra AV after TAVI are still lacking. Our aim was to determine the per‐ and post‐procedural outcomes in patients with Micra AV leadless PM implantation after TAVI. Methods A total of 20 consecutive patients underwent Micra AV leadless PM implantation after TAVI between November 2020 and June 2021. Results The main indication for ventricular pacing was high‐degree AV block (55% of patients) and left bundle branch block (LBBB) associated with prolonged HV interval (45% of patients). At discharge, mean (SD) ventricular pacing threshold was 0.397 ± 0.11 V at 0.24 ms and ventricular impedance was 709.4 ± 139.1 Ω. At 1‐month follow‐up, 95% of patients were programmed in VDD pacing mode. Mean (SD) ventricular pacing threshold was 0.448 ± 0.094 V at 0.24 ms. In patients with ventricular> pacing > 90% ( n = 5), mean AM‐VP was 72.5% ± 8.3%. Pacing threshold at 1 month was not significantly different compared to discharge ( p = .1088). Mean (SD) impedance was 631.0 ± 111.9 Ω, which remained stable at discharge ( p = .0813). No procedural complications occurred during implantation. At 1‐month follow‐up, two patients displayed atrial under‐sensing. Conclusions Micra AV leadless PM implantation after TAVI is associated with a low complication rate and good device performance at 1‐month post‐implantation.