Life Cycle Management Of Micra Transcatheter Pacing System: Data From A High-Volume Center

Background Data on the management of Micra transcatheter pacing system (TPS) at the time of an upgrade or during battery depletion is limited.Objective We sought to evaluate the management patterns of patients implanted with a Micra TPS during long-term follow-up.Methods We retrospectively identified patients who underwent Micra implantation from April 2014 to November 2019. We identified patients who underwent extraction (n = 11) or had an abandoned Micra (n = 12).Results We identified 302 patients who received a Micra during the period of the study. Mean age was 72.7 +/- 15.4 years, 54.6% were men, and left ventricular ejection fraction was 51.9 +/- 5.2%. Mean follow-up was 1105.5 +/- 529.3 days. Procedural complications included pericardial tamponade (n = 1) treated with pericardiocentesis, significant rise in thresholds (n = 6) treated with reimplantation (n = 4), and major groin complications (n = 2). Indications for extraction included an upgrade to cardiac resynchronization therapy (CRT) device (n = 3), bridging after extraction of an infected transvenous system (n = 3), elevated thresholds (n = 3), and non-Micra-related bacteremia (n = 2). The median time from implantation to extraction was 78 days (interquartile range: 14-113 days), with the longest extraction occurring at 1442 days. All extractions were successful, with no procedural or long-term complications. Indications for abandonment included the need for CRT (n = 6), battery depletion (n = 2), increasing thresholds/failure to capture (n = 3), and pacemaker syndrome (n = 1). All procedures were successful, with no procedural or long-term complications.Conclusion In this large single-center study, 6% of patients implanted with a Micra required a system modification during long-term follow-up, most commonly due to the requirement for CRT pacing. These patients were managed successfully with extraction or abandonment.