From the Guidelines
The Micra (Medtronic Micra, transcatheter pacing system) pacemaker is indicated for patients with symptomatic bradycardia or conduction disorders, including those with second-degree Mobitz type II atrioventricular block, high-grade atrioventricular block, or third-degree atrioventricular block not caused by reversible or physiologic causes 1.
Indications for Micra Pacemaker
- Symptomatic bradycardia: The Micra pacemaker is suitable for patients with symptomatic bradycardia, including those with sinus node dysfunction or atrioventricular block 1.
- Conduction disorders: Patients with conduction disorders, such as second-degree or third-degree atrioventricular block, may benefit from the Micra pacemaker 1.
- Atrioventricular block: The Micra pacemaker is indicated for patients with atrioventricular block, including those with second-degree Mobitz type II or third-degree atrioventricular block 1.
Key Considerations
- Shared decision-making: The decision to implant a Micra pacemaker should be made using a shared decision-making approach, taking into account the patient's goals of care, preferences, and values 1.
- Patient selection: Patients with significant comorbidities or those who are unlikely to benefit from pacing therapy should not undergo Micra pacemaker implantation 1.
- Alternative therapies: Patients should be informed of alternative therapies and the potential risks and benefits of the Micra pacemaker 1. The Micra pacemaker is a leadless pacing system, which may be preferred in certain patients, such as those with venous obstruction or high risk of lead complications 1. However, the decision to implant a Micra pacemaker should be individualized based on the patient's specific needs and circumstances.
From the Research
Indications for Micra Pacemaker
The Micra pacemaker is indicated for patients with certain heart conditions that require permanent cardiac pacing. The specific indications for the Micra pacemaker include:
- Atrioventricular block (AV block) 2
- Sinus node dysfunction 2
- Bradycardia 3
- Indications for ventricular pacing, including those with atrial fibrillation (AF) and those without AF 4
Patient Selection
Patient selection is a key component of securing optimal patient outcomes with leadless pacing. Patients with a primary pacing indication associated with AF or history of AF, as well as those without AF, can be considered for the Micra pacemaker 4. The decision to implant a Micra pacemaker should be based on individual patient characteristics and needs.
Clinical Evidence
Clinical studies have demonstrated the safety and efficacy of the Micra pacemaker in patients with various indications for permanent cardiac pacing. These studies have shown that the Micra pacemaker can be safely and effectively implanted, with low rates of complications and adverse events 2, 5, 4, 3, 6. The Micra pacemaker has been shown to provide stable pacing parameters and reliable battery performance, with an extremely high implant success rate and significantly lower major complication rates compared to transvenous pacemakers 3.
Key Findings
Some key findings from the clinical studies include:
- The Micra pacemaker can be safely and effectively implanted in patients with AV block, sinus node dysfunction, and other indications for ventricular pacing 2, 6
- The Micra pacemaker has a low rate of complications and adverse events, including major complications related to the system or implant procedure 5, 4
- The Micra pacemaker provides stable pacing parameters and reliable battery performance, with an extremely high implant success rate and significantly lower major complication rates compared to transvenous pacemakers 3