Leadless pacemaker implantations after infectious pacemaker removals in
octogenarians
Abstract
Background: Management of pacemaker (PM) infections in patients with an
advanced age is one of the most sensitive issues, since they possess
particular clinical challenges due to higher rates of medical
comorbidities. The novel leadless pacemaker (LP) requiring no
transvenous lead or device pocket, may provide new opportunities for the
management of PM infections among patients with an advanced age.
Methods: We reviewed 8 octogenarians (median age of 86 [minimum 82 –
maximum 90], male 63%) who received an LP implantation following a
transvenous lead extraction (TLE) of an infectious PM. Results: All
patients had more than 2 medical comorbidities. The indications for the
LP implantations were atrioventricular block in 3 patients, atrial
fibrillation bradycardia in 3, and sinus node dysfunction in 2. Five
patients were bridged with a temporary pacing using an active fixation
lead (median interval of 14.5 days), while one patient with severe
dementia underwent a concomitant LP implantation and TLE during the same
procedure. Successful TLEs and LP implantations were accomplished in all
patients. There were no major or minor complications including vascular
access troubles. All patients were discharged 2–8 days after the
implantation. All patients stayed free of infection during the follow-up
period of 6 months Conclusions: LP implantations were safe and effective
after infected pacemaker removals in all 8 octogenarians. The novel LP
technology may offer an alternative option in considering
re-implantation of a PM even among patients with an advanced age and who
are PM dependent.