Recently, a battery advisory was distributed by Abbott stating that 7 of 1423 (0.5 %) patients had a battery malfunction that occurred more than two years after Nanostim LCP implantation. Of note, there are situations where extraction of the LP may be necessary, such as in infection or dislocation. However, extraction may not be feasible due to encapsulation of the device, and this will probably be more prevalent with more chronic use of LP therapy. The second replacement strategy is to extract the LP and subsequently implant a new device. Multiple devices in the heart may compromise cardiac function, or be a source of interference. Important concerns have been raised regarding the aforementioned option. The LP can be abandoned and an additional device may be implanted adjacent to the non-functional LP. LPs were designed so that they can be programmed in a non-functional mode. Once the EOL of the LP approaches, there are two options for implanting physicians to address this problem. 2,3,9 Therefore, selected patients might require multiple devices over their lifespan. The estimated battery longevity of the LP ranges between 4.7 and 15 years, depending on pacing parameters. 7 Optimal EOL strategy of LP therapy is subject to debate. 8 Up to three leads can be placed intracardially, without haemodynamic compromise. 7 PM lead extraction can be a high-risk procedure and is associated with serious complications, including cardiac perforation and death. 7,8 The subcutaneous generator is readily accessible for replacement, leaving the leads in place. The optimal approach at the end of service of conventional transvenous PM therapy has been studied in great detail. 6ĭespite these promising results, there is an important challenge to consider: the end-of-life (EOL) management of LP therapy. demonstrated that long-term complication rates are expected to decrease by 71 % following Nanostim LCP implantation compared to conventional transvenous PM therapy. Micra TPS had fewer major complications compared to patients in the historical control cohort at 6-month follow-up: 4.0 % versus 7.4 %, respectively. performed a post hoc analysis of patients who received Micra TPS implantation compared with patients who underwent transvenous PM therapy in a historical control cohort. 3,4 The LPs demonstrated similar pacing performance and safety results, and exhibit high implantation success rates. The LPs have shown to meet the pre-specified safety and performance criteria in two large prospective multicentre single-arm studies. 1-4 To date, two LPs are available for patients with a single-chamber pacing (VVI) indication: the Nanostim Leadless Cardiac Pacemaker (LCP Abbott) and the Micra Transcatheter Pacing System (TPS Medtronic). Since its introduction in 2012, leadless pacemaker (LP) therapy has developed as a therapeutic alternative to conventional transvenous pacemaker (PM) therapy to circumvent lead- and pocket-related complications. Therefore, long-term prospective analysis is required to define the most optimal end-of-life strategy. The potential inability to retrieve chronically implanted leadless pacemakers limits the application of this novel technology. In addition, potential risks for device–device interference, and unknown long-term complications associated with multiple intracardiac devices are prevented. We suggest that the approach of leadless pacemaker retrieval is more appealing to limit the amount of non-functioning intracardiac hardware. Although initial studies demonstrate promising results, early experience of acute and mid-term retrieval feasibility and safety remains mixed. Suggested strategies comprise of (a) placing an additional leadless device adjacent to the leadless pacemaker, or (b) retrieving the non-functioning leadless pacemaker and subsequently implanting a new device. However, the optimal end-of-life strategy of this novel technique is undefined. The clinically available leadless pacemakers for patients with a single-chamber pacing indication have shown to be safe and effective.
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