Leadless Pacemaker Implantation Under Direct Visualization During Valve Surgery

Abstract Objective The leadless cardiac pacemaker is typically implanted percutaneously, and has been widely used for patients who have already undergone valve surgery. We sought to determine the feasibility and safety of implanting the leadless pacemaker under direct visualization during valve surgery. Methods Retrospective analysis of consecutive adult patients (n=15) who underwent implantation of a leadless pacemaker under direct visualization at the time of valve surgery. Indications for single-chamber pacing were sick sinus syndrome with pauses (53.3%), atrial fibrillation with slow ventricular rates (13.3%) or complete heart block (6.6%) and elevated risk for post-operative heart block (26.6%). Leadless pacemaker performance and pacing-percentage were assessed. Results The cohort was 67.5±17 years old, 6 (40%) were males and 14 (93%) had atrial fibrillation. Isolated tricuspid valve replacement was performed in 5 (33.3%), the remainder underwent multi-valve surgery which included concomitant tricuspid valve repair/replacement. In 93% of the patients (n=14), the immediate post-CPB pacing thresholds were normal (≤2.0 V @ 0.24 ms), and normalized in the remaining patient by the next morning. The impedance/sensing values were normal and stable thru follow-up (151 ± 119 days) in all patients. Reliable leadless pacemaker performance allowed for allowed deferral of temporary epicardial wires in 11 patients (73%). There were no procedural complications or device malfunction. Conclusions Leadless cardiac pacemaker implantation during valve surgery is feasible and safe. This hybrid approach to pacing may simplify the peri-operative management of patients undergoing valve surgery who have an indication for single-chamber pacing.