Upgrade van draadloze pacemaker: van enkelvoudig naar tweekamersysteem

AIMS: The aim of this analysis was to evaluate the upgradeability of a single-chamber leadless pacemaker (LP) to a dual-chamber system in patients indicated for a dual-chamber pacemaker. METHODS AND RESULTS: A prospective, multicentre study evaluated the safety and performance of a dual-chamber LP. The study included patients with a prior ventricular LP to evaluate its upgradeability. Patients had an attempted atrial LP implant, and if successfully implanted, the LPs were paired to a dual-chamber pacing mode to evaluate upgrade success. Patients were followed for 12 months from the attempted atrial LP implantation. Among 35 patients with an attempted upgrade (62.9% male, average age 70 years), the most common primary indication was sinus node dysfunction (57.1%). Out of 35 patients, 91.4% had successful upgrades. The mean atrial device electrical measurements stabilized within 1 month from the procedure and remained stable through 12 months (capture threshold at 0.4 ms 0.8 ± 0.6 V, sense amplitude 4.5 ± 2.7 mV at 12 months). A total of five (14.3%) patients experienced seven complications, all of which were procedure-related. There were no device or procedure-related deaths. The total estimated battery longevity (accounting for time since implant) evaluated at 12 months was 11.3 ± 4.2 and 5.7 ± 2.6 years for the ventricular and atrial LPs, respectively. One patient required an atrial LP revision 10 months after implantation. The LP was retrieved and replaced. CONCLUSION: These data confirm the feasibility, safety, and long-term effectiveness of adding an atrial LP in patients with a pre-existing ventricular LP to achieve dual-chamber leadless pacing.