Right Ventriculography Improves the Accuracy of Micra TM Leadless
Pacemaker Implantation in Right Ventricular Mid-Septum
Abstract
Background: Implanting leadless pacemakers in the right
ventricular (RV) apex is prone to causing pericardial tamponade and
myocardial perforation. Objective: To investigate the
feasibility and safety of right ventriculography-guided implantation of
Micra TM leadless pacemaker (Micra) in the RV
mid-septum. Methods: 108 consecutive patients who underwent
Micra implantation intended in the mid-septum were enrolled and
randomized (3:1) into the radiography group (n=81) with assistance of
right ventriculography to illustrate the RV septum and the
non-radiography group (n=27). All subjects underwent a postoperative
computed tomography (CT) scan to determine the Micra location. The Micra
location assessed by CT image was compared between the two groups to
confirm the accuracy of the intended pacing site. The duration of the
procedure, X-ray exposure dose and time were also compared between the
two groups. Results: Reconstructed CT 3-D cardiac imaging found
the Micra location in the intended mid-septum in 13 patients (48.1%,
13/27) in the non-radiography group and 76 patients (93.8%, 76/81) in
the radiography group ( P< 0.0001 between two groups).
There was no significant difference in procedure interval between the
two groups while the X-ray exposure (564.86±112.44 vs. 825.85±156.12mGy,
P < 0.0001), X-ray exposure time (7.79±1.43vs. 12.03±2.86 min,
P < 0.0001) and the number of fluoroscopy re-positioning
(2.79±1.03, vs. 6.41±1.82, P<0.0001) were significantly less
in the radiography group than in the non-radiography group. No
implantation-related complications were observed in both groups.
Conclusion Right ventriculography increases the accuracy of
Micra TM pacemaker implantation in the mid-septum and
reduces X-ray exposure.