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Leadless pacemaker implantations after infectious pacemaker removals in octogenarians
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  • SATOSHI HIGUCHI,
  • Morio Shoda,
  • Daigo Yagishita,
  • Satoshi Saito,
  • Ayako Okada,
  • Miwa Kanai,
  • Shohei Kataoka,
  • Kyoichiro Yazaki,
  • Hiroaki Tabata,
  • Hideki Kobayashi,
  • Takahiro Okano,
  • Wataru Shoin,
  • Koji Yoshie,
  • Koichiro Ejima,
  • Koichiro Kuwahara,
  • Nobuhisa Hagiwara
SATOSHI HIGUCHI
Tokyo Women's Medical University
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Morio Shoda
Tokyo Women's Medical University
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Daigo Yagishita
Tokyo Women's Medical University
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Satoshi Saito
Tokyo Women's Medical University
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Ayako Okada
Shinshu University
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Miwa Kanai
Tokyo Women's Medical University Hospital
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Shohei Kataoka
Tokyo Women's Medical University Hospital
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Kyoichiro Yazaki
Tokyo Women's Medical University
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Hiroaki Tabata
Shinshu University
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Hideki Kobayashi
Shinshu University
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Takahiro Okano
Shinshu University
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Wataru Shoin
Shinshu University
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Koji Yoshie
Shinshu University
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Koichiro Ejima
Tokyo Women's Medical University
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Koichiro Kuwahara
Shinshu University
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Nobuhisa Hagiwara
Tokyo Women's Medical University
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Abstract

Background: Management of pacemaker (PM) infections in patients with an advanced age is one of the most sensitive issues, since they possess particular clinical challenges due to higher rates of medical comorbidities. The novel leadless pacemaker (LP) requiring no transvenous lead or device pocket, may provide new opportunities for the management of PM infections among patients with an advanced age. Methods: We reviewed 8 octogenarians (median age of 86 [minimum 82 – maximum 90], male 63%) who received an LP implantation following a transvenous lead extraction (TLE) of an infectious PM. Results: All patients had more than 2 medical comorbidities. The indications for the LP implantations were atrioventricular block in 3 patients, atrial fibrillation bradycardia in 3, and sinus node dysfunction in 2. Five patients were bridged with a temporary pacing using an active fixation lead (median interval of 14.5 days), while one patient with severe dementia underwent a concomitant LP implantation and TLE during the same procedure. Successful TLEs and LP implantations were accomplished in all patients. There were no major or minor complications including vascular access troubles. All patients were discharged 2–8 days after the implantation. All patients stayed free of infection during the follow-up period of 6 months Conclusions: LP implantations were safe and effective after infected pacemaker removals in all 8 octogenarians. The novel LP technology may offer an alternative option in considering re-implantation of a PM even among patients with an advanced age and who are PM dependent.