ヒグチ　サトシ   HIGUCHI Satoshi   樋口　諭    所属   医学部 医学科（東京女子医科大学病院）    職種   寄附部門講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Leadless cardiac pacemaker implantations after infected pacemaker system removals in octogenarians.
掲載誌名	正式名：Journal of geriatric cardiology : JGC 略　 称：J Geriatr Cardiol ISSNコード：16715411/16715411
掲載区分	国外
巻・号・頁	18(7),pp.505-513
著者・共著者	Higuchi Satoshi, Okada Ayako, Shoda Morio, Yagishita Daigo, Saito Satoshi, Kanai Miwa, Kataoka Shohei, Yazaki Kyoichiro, Tabata Hiroaki, Kobayashi Hideki,, Shoin Wataru, Okano Takahiro, Yoshie Koji, Ejima Koichiro, Kuwahara Koichiro, Hagiwara Nobuhisa
発行年月	2021/07
概要	BACKGROUND:Management of pacemaker (PM) infections among advanced aged patients possesses particular clinical challenges due to higher rates of concurrent cardiovascular disease and medical comorbidities. Novel leadless cardiac pacemakers (LCPs) may provide new opportunities for better management options in this population, however, there is limited data especially in Asian populations to guide the decision making.METHODS:We reviewed 11 octogenarians (median age: 86 [minimum 82-maximum 90] years; male: 73%; median body mass index (BMI): 20.1 kg/m2) who received Micra Transcatheter Pacing System (Medtronic Inc, Minneapolis, MN) implantations following transvenous lead extractions (TLEs) for PM infections.RESULTS:All patients had more than two medical comorbidities (average 3.7 comorbidities). The indications for LCP implantations were atrioventricular block in four patients, atrial fibrillation bradycardia in five, and sinus node dysfunction in two. Eight patients (73%) were bridged with temporary pacing using active fixation leads (median interval of 14.0 days), while one with severe dementia underwent a concomitant LCP implantation and TLE during the same procedure. Successful TLEs and LCP implantations were successfully accomplished in all without any complications. The median time from the TLE procedure to discharge was 22 days (minimum 7-maximum 136). All patients remained free of infections during a mean follow-up period of 17.2 ± 6.5 months.CONCLUSIONS:LCP implantations were safe and effective after removing the entire infectious PM system in all octogenarians. The novel LCP technology may offer an alternative option for considering a re-implantation strategy after transvenous PM infections in elderly patients, particularly those with severe frailty and PM dependency.
DOI	10.11909/j.issn.1671-5411.2021.07.006
PMID	34404987