Author + information
- J.L. Martínez-Sande,
- J. García-Seara,
- L. González-Melchor,
- M. Rodríguez-Mañero,
- X.A. Fernández-López,
- D. Iglesias-Alvarez,
- V. González-Salvado and
- J.R. González-Juanatey
Feasibility of concurrent leadless-pacemaker (LDP) implantation plus atrioventricular (AV) node ablation is unknown. Moreover, safety issues in the long run are also undetermined. It seems theoretically attractive since it could avoid one additional procedure and catheter could be introduced through the same sheath employed for the LDP. On the contrary, risk of dislocation/electrical variations could represent a shortcoming.
We aim to report 1) feasibility of concomitant AV node ablation after a LDP implantation and 2) mid-term outcomes.
Prospective, observational study of 74 consecutive patients with an indication for single-chamber pacemaker placement ≥ 65 years. The implantation procedure was carried out using a femoral approach and conventional technique.
15 out of 74 (20,3%) patients underwent immediate AV ablation. Mean age was 75.5±9,3 years. All of them were females and indication was fast conduction atrial fibrillation (n=11), atypical atrial flutter (3) or atrial tachycardia (n=1). Mean acute “R wave” was 11.8mV, threshold of 0.66V/0.24ms and impedance of 787Ω. Uneventful AV node ablation was performed in all of them immediately after LDP implantation. Additional mean fluoroscopic time was 3.5 minutes. There were no vascular or arrhythmic complications after the implantation. After a mean follow-up of 10± 8 months, all patients remained alive without notable event, electrical parameters remained unchanged.
Immediate AV node ablation after LDP implantation seems feasible without remarkable complications in the long run. In our pilot experience, this approach appears more comfortable for the patients and less time-consuming than conventional pacemaker implantation with sequential AV node ablation.