Rendimiento del marcapasos cardiaco Micra en nonagenarios / Performance of the Micra cardiac pacemaker in nonagenarians

INTRODUCCIÓN Y OBJETIVOS: El marcapasos transcatéter Micra presenta una alta efectividad y una tasa de complicaciones más baja que los marcapasos convencionales. Sin embargo, se desconoce su beneficio en la población más anciana (≥ 90 años). El objetivo de este estudio es evaluar la efectividad y la seguridad de Micra en pacientes de edad ≥ 90 años. MÉTODOS: Estudio observacional prospectivo con pacientes consecutivos mayores de 70 años a los que se implantó un marcapasos Micra, divididos en 2 grupos de edad: ≥ 90 y <90 años. RESULTADOS: El Micra se implantó en 129 pacientes, 41 tenían 90 o más años y 88, menos de 90. El implante fue exitoso en 40 pacientes (97,6%) de edad ≥ 90 años y en 87 (98,9%) menores de 90 (p = 0,58). Fueron necesarias 2 o menos reposiciones en el 97,5 y el 91,9% de los pacientes respectivamente (p = 0,32). Los tiempos de procedimiento (26,1±11,6 frente a 30,3±14,2min; p = 0,11) y de fluoroscopia (6,4±4,7 frente a 7,2±4,9min; p = 0,41) fueron similares en ambos grupos. Hubo 3 complicaciones mayores (2,3%), todas en el grupo menor de 90 años: 1 perforación cardiaca, 1 hematoma femoral y 1 seudoaneurisma femoral. Un total de 13 pacientes de edad ≥ 90 años (31,7%) y 16 de los menores de 90 (18,2%) murieron durante unos seguimientos medios de 230±233 y 394±285 días respectivamente. No hubo muertes relacionadas con el dispositivo. No se observaron infección, dislocación o migración de Micra. El rendimiento eléctrico fue óptimo en el seguimiento. CONCLUSIONES: El marcapasos sin cables Micra parece efectivo y seguro en pacientes mayores de 90 años. Podría considerarse una alternativa razonable a la estimulación transvenosa convencional en esta población

INTRODUCTION AND OBJECTIVES: The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years. METHODS: We present a prospective observational study with consecutive patients aged >70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and<90 years. RESULTS: The Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88<90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients<90 years (P=.58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively (P=.32). Procedure time (26.1 ±11.6 vs 30.3 ±14.2minutes; P=.11) and fluoroscopy time (6.4 ±4.7 vs 7.2 ±4.9minutes; P=0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged<90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged <90 years (18.2%) died during a mean follow-up of 230±233 days and 394±285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. CONCLUSIONS: The Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population

Performance of the Micra cardiac pacemaker in nonagenarians.

INTRODUCTION AND OBJECTIVES: The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years. METHODS: We present a prospective observational study with consecutive patients aged >70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and<90 years. RESULTS: The Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88<90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients<90 years (P=.58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively (P=.32). Procedure time (26.1 ±11.6 vs 30.3 ±14.2minutes; P=.11) and fluoroscopy time (6.4 ±4.7 vs 7.2 ±4.9minutes; P=0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged<90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged <90 years (18.2%) died during a mean follow-up of 230±233 days and 394±285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. CONCLUSIONS: The Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population.