Content area
Full text
Background
The advent of the leadless pacemaker, a revolutionary device that integrates a pulse generator with pacing electrodes, has effectively overcome complications associated with the pouch and leads characteristic of conventional pacemakers. This innovation not only enhances patient safety but also significantly improves their quality of life [1]. However, despite its advantages, this pacemaker is not suitable for His-bundle pacing. In patients with high pacing demands, it may disrupt the natural ventricular activation sequence, leading to cardiac dyssynchrony. This not only amplifies sympathetic nerve activity but can also trigger pacemaker-induced cardiomyopathy (PICM), which can impair the heart’s contractile function, culminating in cardiac dysfunction [2, 3].
Prior studies indicate that pacing location can influence the breadth and synchrony of the QRS complex [4]. Furthermore, right ventricular pacing that induces dyssynchrony between the ventricles is correlated with an increased prevalence of tricuspid valve insufficiency [5]. In light of this, our study leverages cardiac ultrasonography to meticulously assess the effects of various implantation sites of the leadless pacemaker on cardiac synchrony and tricuspid valve function. Our objective is to identify the optimal implantation site, offering crucial insights for future leadless pacemaker placements.
Methods
Study population
This dual-center clinical trial, conducted from March 2022 to February 2023, enrolled 53 patients from the Second Affiliated Hospital of Zhejiang University School of Medicine and the First People’s Hospital of Hangzhou. Inclusion criteria required patients to consent to the implantation of a leadless pacemaker. Exclusion criteria were: 1) presence of inferior vena cava or portal vein thrombosis, tumor thrombus, or inferior vena cava malformation; 2) femoral vein stenosis or tortuosity preventing the accommodation of the pacemaker delivery system; 3) patients in the acute phase of myocardial infarction; 4) patients with implanted devices that interfere with the pacemaker delivery system, such as inferior vena cava filters or mechanical tricuspid valve replacements; and 5) patients unable to comprehend or unwilling to complete an informed consent form for follow-up. The patients were assigned to two groups according to the implantation site of their leadless pacemaker for intergroup comparisons.Ethical considerations related to this study underwent thorough review and approval by the Ethics Committee of the two hospitals. All patients provided written informed consent.
Implantation of leadless pacemaker
The leadless pacemaker implantation procedure is performed under local...