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Peak deflection index as a predictor of a free-wall implantation of contemporary leadless pacemakers

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Abstract

Background

Leadless pacemakers are an effective treatment for bradycardia. However, some cases exhibit pericardial effusions, presumably associated with device implantations on the right ventricular free-wall. The present study was carried out to find the ECG features during ventricular pacing with a Micra, which enabled distinguishing free-wall implantations from septal implantations without using imaging modalities.

Methods

Thirty-one consecutive patients who received Micra implantations in our facility were enrolled. The location of the device in the right ventricle was evaluated using echocardiography or computed tomography in order to determine whether the device was implanted on the septum (Sep group), apex (Apex group), or free-wall (FW group). The differences in the 12-lead ECG during ventricular pacing by the Micra were analyzed between the Sep and FW groups.

Results

The body of the Micra was clearly identifiable in 22 patients. The location of the device was classified into Sep in 12 patients, Apex in 4, and FW in 6. The mean age was highest in the FW and lowest in the Sep group (82.7 ± 6.6 vs. 72.8 ± 8.7 years, p = 0.027). The peak deflection index (PDI) was significantly larger in the FW group than Sep/Apex group in lead V1 (Sep: 0.505 ± 0.010, Apex: 0.402 ± 0.052, FW: 0.617 ± 0.043, p = 0.004) and lead V2 (Sep: 0.450 ± 0.066, Apex: 0.409 ± 0.037, FW: 0.521 ± 0.030, p = 0.011), whereas there was no difference in the QRS duration, transitional zone, and QRS notching.

Conclusion

The PDI in V1 could be useful for predicting implantations of Micra devices on the free-wall and may potentially stratify the risk of postprocedural pericardial effusions.

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Acknowledgements

We thank Mr. John Martin for his linguistic assistance in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Takatsugu Kajiyama, Kazuo Miyazawa, Miyo Nakano, Tomohiko Hayashi, Ryo Ito, Haruhiro Takahira, Mari Kitagawa & Yoshio Kobayashi

  2. Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan

    Yusuke Kondo & Masahiro Nakano

Authors
  1. Takatsugu Kajiyama
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  2. Yusuke Kondo
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  4. Kazuo Miyazawa
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  5. Miyo Nakano
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  6. Tomohiko Hayashi
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Correspondence to Takatsugu Kajiyama.

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Kajiyama, T., Kondo, Y., Nakano, M. et al. Peak deflection index as a predictor of a free-wall implantation of contemporary leadless pacemakers. J Interv Card Electrophysiol 60, 239–245 (2021). https://doi.org/10.1007/s10840-020-00724-y

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  • DOI: https://doi.org/10.1007/s10840-020-00724-y

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