B-po05-061 safety of intraoperative placement of permanent leadless pacemakers compared to temporary epicardial wire placement

Since the risk of post-op bradyarrhythmias is high after tricuspid valve or aortic valve surgery, placement of temporary epicardial pacing (TEP) wires has a Class I indication. Intraoperative placement of a leadless cardiac pacemaker (LCP) avoids the need for monitoring with TEP and their associated complications. To compare the safety of intraoperative LCP against post-operative monitoring with TEP wires in patients who ultimately undergo pacemaker placement. Single-center review of patients who underwent valve surgery from 8/2018-11/2020 and received an LCP (Medtronic, Micra) either i) intraoperatively without adjunctive TEP wires (n=23; Figure) or ii) post-operatively with TEP (n = 23). There were no procedural complications/adverse pacing events with intra-operative LCP implantation without TEP wire placement. Of patients with TEP in place, two (8.7%) required urgent implantation of transvenous pacing leads after pacing needs developed post-TEP removal. One patient received an urgent permanent pacemaker after TEP leads failed and lost capture. TEP wires remained in place for a median of 9 days. Despite additional monitoring in the TEP group, both groups had similar rates of moderate pacing (>40% RV pacing) at 30-day follow-up (44% TEP vs 28% Intraop, p = 0.298). There were no pacing related complications in patients who underwent intraoperative LCP implantation without temporary epicardial leads. Temporary epicardial leads have been associated with pacing related complications (R-on-T) and can fail over time. Studies on the financial implications of this strategy are warranted.