INTRODUCTION
Critically ill patients may present a permanent, or at least prolonged,
indication of cardiac pacing, either because they are hospitalized
following severe bradycardia, or because they incidentally develop
repetitive or persistent bradycardia episodes in addition to a primary
severe medical condition [1]. These patients may initially require
transvenous temporary pacing (TTP), and if bradycardia persists,
eventually the implantation of a permanent cardiac pacemaker (PPM).
Conventional transvenous PPM implantation can be challenging in patients
with multiple central venous lines. It is also associated with an
increased risk of severe complications, such as pneumo/haemothorax,
haematoma, cardiac injury, lead dislodgement, and of course infection
(local pocket and/or lead endocarditis) which often drives the prognosis
in this population [2].
Leadless pacemakers (LPMs) have recently emerged as a useful tool in
patients requiring a permanent single-chamber pacing device [3,4].
They have been shown to be associated with a low rate of complications,
especially a virtually zero risk of infection, even in patients with a
previous device infection [5,6]. Moreover, as their implantation is
performed through a transvenous femoral approach, they are first-choice
devices in patients with unsuitable supracaval venous access.
We sought to evaluate the safety and efficacy of LPM implantation in the
high-risk population of patients hospitalized in intensive care unit
(ICU) who require prolonged cardiac pacing.