• Poojita Shivamurthy, Marc A Miller, Ahmed El-Eshmawi, Percy Boateng, Dimosthenis Pandis, Amit Pawale, Dror B Leviner, Ana Claudia Costa, Chartaroon Rimsukcharoenchai, Menachem M Weiner, Benjamin Salter, Morgan L Montgomery, Anelechi Anyanwu, and David H Adams.
• Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: poojita.shivamurthy@mountsinai.org.
• J. Thorac. Cardiovasc. Surg. 2022 May 1; 163 (5): 1818-1825.

ObjectiveThe leadless cardiac pacemaker is typically implanted percutaneously and has been widely used for patients who have already undergone valve surgery. We sought to determine the feasibility and safety of implanting the leadless pacemaker under direct visualization during valve surgery.MethodsWe performed a retrospective analysis of consecutive adult patients (n = 15) who underwent implantation of a leadless pacemaker under direct visualization at the time of valve surgery. Indications for single-chamber pacing were sick sinus syndrome with pauses (53.3%), atrial fibrillation with slow ventricular rates (13.3%) or complete heart block (6.6%), and elevated risk for postoperative heart block (26.6%). Leadless pacemaker performance and pacing percentage were assessed.ResultsPatients' age was 67.5 ± 17 years, 6 patients (40%) were male, and 14 patients (93%) had atrial fibrillation. Isolated tricuspid valve replacement was performed in 5 patients (33.3%), and the remainder underwent multivalve surgery that included concomitant tricuspid valve repair/replacement. In 93% of the patients (n = 14), the immediate post-cardiopulmonary bypass pacing thresholds were normal (≤2.0 V at 0.24 ms) and normalized in the remaining patient by the next morning. The impedance/sensing values were normal and stable through follow-up (151 ± 119 days) in all patients. Reliable leadless pacemaker performance allowed for deferral of temporary epicardial wires in 11 patients (73%). There were no procedural complications or device malfunction.ConclusionsLeadless cardiac pacemaker implantation during valve surgery is feasible and safe. This hybrid approach to pacing may simplify the perioperative management of patients undergoing valve surgery who have an indication for single-chamber pacing.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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