Initial Experience With a Leadless Pacemaker (Micra™) Implantation in a Low Volume Center in South East Asia

Figures & data

Figure 1. Micra Transcatheter Pacing System implant procedure.

Table 1. Characteristics of patients with Micra Transcatheter Pacing System implants.

CASE no.	1	2	3	4^†	5^#	6	7^‡	8	9^#
Age and sex	38, F	84, M	69, M	64, M	84, M	81, F	73, F	80, F	83, F
Diagnosis	Down’s syndrome, SSS	Persistent AF bradycardia	Persistent AF bradycardia	SSS, no venous access to SVC	Persistent AF bradycardia	Persistent AF bradycardia	Persistent AF bradycardia	Persistent AF bradycardia	No venous access, old pacemaker lead fractured, capped
Anesthesia	General	General	General	General	General	Local + sedation	Local + sedation	Local + sedation	Local + sedation
Implant site	RV apical-septum	RV apical-septum	RV mid-septum	RV apical-septum	RV apical-septum	RV apical-septum	RV apical-septum	RV apical-septum	RV mid-septum
Procedure time	98 min	58 min	54 min	30 min	50 min	100 min	66 min	68 min	73 min
Fluoroscopy time	5.48 min	7.35 min	11.28 min	4.06 min	6.43 min	10.29 min	10.10 min	10.18 min	18.23 min
Deployments	Single	Single	Single	Single	Twice (inadequate fixing)	Single	Single	Single	Twice (inadequate pacing)
Puncture closure	Pro Glide + Z suture	Pro Glide	Pro Glide	Pro Glide	Pro Glide	Pro Glide	Pro Glide + Z suture	Pro Glide + Z suture	Pro Glide + Z suture
Impedance	550	600	610	640	500	740	790	930	620
Implant threshold (@ 0.24 ms)	0.63	0.38	0.63	0.5	0.75	0.5	0.38	0.63	0.50
Implant R (mV)	11	7.3	8.1	17.9	9.5	13.3	5.4	9.7	6.6
1-Month R (mV)	11.5	5.9	8.9	13.2^†	8.7	12.6	5.5	10.0	5.1
1-Month threshold (@ 0.24 ms)	0.38	0.5	0.5	0.75	0.63	0.5	0.38	0.5	0.5
Warfarin (INR)	No (1)	Yes (2.1)	Yes (2.1)	No (1.1)	Yes (2.5)	Yes (2.3)	Yes (2.0)	Yes (2.6)	No (0.9)
Complications	None	None	None	None	None	None	None	None	None

^†Day 14 patient developed VT/VF and needed DC Sock @ 360 J. Pacing parameters remained stable.

^‡Done from left femoral.

^#Redeployments done due to inadequate fixing in Case 5 and unacceptable pacing parameters in Case 9.

AF: Atrial fibrillation; INR: International normalized ratio; mV: Millivolt; RV: Right ventricle; R: R wave amplitude; SSS: Sick sinus syndrome; SVC: Superior vena cava; VF: Ventricular fibrillation; VT: Ventricular tachycardia.