title: Transcatheter leadless cardiac pacing: The new alternative solution.
abstract: BACKGROUND
  A lack of information about the feasibility and safety of leadless pacemaker (LPMs) exists in a fragile population of patients with limited venous anatomy access or conventional pacemaker (PM) contraindication. Accordingly, the goal of this prospective observational study was to report our experience with this new leadless technology in a subset of patients with contraindication or limited venous access.
  
  
  RESULTS
  Between May 2015 and July 2016, 14 patients were consecutively included. The indications for initial PM implantation were atrioventricular (AV) block in 10/14 patients (71%), bradyarrhythmia in one (7%), and uncontrolled atrial fibrillation (AFib) requiring AV-node ablation in three (21.5%). AFib was observed in 9 of the 14 patients (64.3%) and 3 were completely dependent with no escape rhythm (21.5%). Normal access pathways via the right or left subclavian veins were occluded due to previous PM implantations and revisions in 4 patients (28.6%) and total vena cava occlusion in 3 (21.4%). End-stage renal disease with hemodialysis was present in 8 (57%) with either local-device infections or presence of long-term implanted dialysis catheters. Evidence of previous bilaterally-infected pectoral tissue was present in 3 patients (21.5%). All procedures were successful (100%) and electrical parameters remained stable over time. No direct pacemaker-related adverse events were reported, including mechanical complications, except for one ventricular fibrillation one day post-implantation under very specific conditions.
  
  
  CONCLUSIONS
  This series demonstrated very stable performance and reassuring safety results during mid-term follow-up in a very fragile population requiring a PM. The Micra LPM constitutes an excellent alternative to the epicardial surgical approach in this very fragile population.
authors.affiliation: Division of Cardiology, Jean Monnet University (ADC, AA, CRB, LA, ZA, JBG, AG, and KI), Saint-Etienne, France. Electronic address: dakosta@orange.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
authors.affiliation: Division of Cardiology, Jean Monnet University (ADC, AA, CRB, LA, ZA, JBG, AG, and KI), Saint-Etienne, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Axiotis
authors.affiliation: Division of Cardiology, Jean Monnet University (ADC, AA, CRB, LA, ZA, JBG, AG, and KI), Saint-Etienne, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Romeyer-Bouchard
authors.affiliation: Division of Cardiology, Jean Monnet University (ADC, AA, CRB, LA, ZA, JBG, AG, and KI), Saint-Etienne, France.
authors.forename: Loucif
authors.initials: L
authors.lastname: Abdellaoui
authors.affiliation: Division of Cardiology, Jean Monnet University (ADC, AA, CRB, LA, ZA, JBG, AG, and KI), Saint-Etienne, France.
authors.forename: Zahi
authors.initials: Z
authors.lastname: Afif
authors.affiliation: Division of Cardiology, Jean Monnet University (ADC, AA, CRB, LA, ZA, JBG, AG, and KI), Saint-Etienne, France.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Guichard
authors.affiliation: Division of Cardiology, Jean Monnet University (ADC, AA, CRB, LA, ZA, JBG, AG, and KI), Saint-Etienne, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gerbay
authors.affiliation: Division of Cardiology, Jean Monnet University (ADC, AA, CRB, LA, ZA, JBG, AG, and KI), Saint-Etienne, France.
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D004566:Electrodes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D061214:Patient Safety / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome
keywords: Heart-block; Leadless pacemaker; Pacemaker infections; Renal failure; Vascular abnormality; Venous occlusion