Performance of the Micra cardiac pacemaker in nonagenarians

• Published in: Revista española de cardiología (English ed.) Vol. 73; no. 4; pp. 307 - 312
• Main Authors: El Amrani, Amine, Campos, Bieito, Alonso-Martín, Concepción, Guerra-Ramos, José M, Rodríguez-Font, Enrique, Moreno-Weidmann, Zoraida, Alcalde-Rodríguez, Óscar, Méndez-Zurita, Francisco J, Santaló, Miguel, Espinosa-Viamonte, Hildemari, Viñolas, Xavier
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01-04-2020
• Subjects: Aged; Aged, 80 and over; Bradicardia; Bradycardia; Bradycardia - physiopathology; Bradycardia - therapy; Capture threshold; Cardiovascular; Equipment Design; Female; Humans; Internal Medicine; Leadless pacemaker; Male; Marcapasos; Marcapasos sin cables; Micra; Nonagenarian; Nonagenario; Pacemaker; Pacemaker, Artificial; Prospective Studies; Registries; Sinoatrial Node - physiopathology; Treatment Outcome; Umbral de captura; transcatheter pacing system; Nonagenario; Marcapasos sin cables; Bradicardia; Umbral de captura; Capture threshold; Bradycardia; Pacemaker; TPS; Micra; Marcapasos; Leadless pacemaker; Nonagenarian
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2019.06.001

AbstractIntroduction and objectivesThe Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years.MethodsWe present a prospective observational study with consecutive patients aged > 70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and < 90 years. ResultsThe Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88 < 90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients < 90 years ( P= .58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively ( P= .32). Procedure time (26.1 ± 11.6 vs 30.3 ± 14.2 minutes; P= .11) and fluoroscopy time (6.4 ± 4.7 vs 7.2 ± 4.9 minutes ; P= 0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged < 90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged < 90 years (18.2%) died during a mean follow-up of 230 ± 233 days and 394 ± 285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. ConclusionThe Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population.