Expert opinion on a safe same day discharge strategy as standard of care after leadless pacemaker implantation

TL;DR

Experts developed a safe same-day discharge pathway for patients after leadless pacemaker implantation to guide medical teams.

Contribution

A novel expert-consensus pathway for safe same-day discharge after Micra™ implantation is proposed.

Findings

Social factors and comorbidities are critical in determining suitability for same-day discharge.

Ultrasound guidance during implantation reduces complications and supports same-day discharge.

Post-procedure observation for 6 hours and in-person follow-up within 1–4 weeks are essential for safety.

Abstract

Key factors to consider before and after Micra™ implantation when deciding on same day discharge.

Leadless pacemaker (LPs) is a safe and effective alternative to conventional transvenous pacing. There is currently no guidance on which patients could be safely discharged the same day post-procedure.

To provide guidance to medical teams regarding safe same day discharge (SDD) after LP implantation.

An Advisory Board (AB) of 6 expert Micra™ implanters was formed. Interviews were conducted with each member to understand their experience on patient selection, care pathway, complications, and follow-up of Micra™ implanted patients. This information was used to develop a patient pathway for safe SDD after Micra™ implantation. A further survey was conducted to obtain consensus regarding decision points within the pathway.

The SDD after Micra™ Implantation Patient Pathway consists of four phases:

Pre-procedure assessment: Social factors are key in deciding suitability of SDD (6/6 AB members agreed, 100%). Patient’s comorbidities, frailty status and timing of procedure are also important in decision-making for SDD.

Micra™ implant: Ultrasound-guidance reduces vascular access-related complications, increasing the likelihood for SDD (100%).

Post-procedure observation: Peri-procedural complications such as pericardial effusion, severe vascular complications, bleeding from access site and device complications would prevent SDD (100%). Patients should complete 6 h of observation prior to discharge (100%).

Follow-up: First follow-up should be in-person, 1–4 weeks post-procedure (84 %). Long-term follow-up should be organised as per Micra™ standard of care at each centre (100 %).

SDD after Micra™ Implantation Patient Pathway was developed via expert consensus. Adoption of the pathway in clinical practice may facilitate safe SDD after Micra™ Implantation.

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