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The operator remained at the femoral site, wearing proper personal protective equipment (PPE) and a sterile gown to minimize radiation as well as infectious exposure. The patient’s face was masked and lightly covered with a sterile drape to reduce the spread of droplet and aerosol particles. A standard sterile technique was maintained throughout the procedure. Fixation and electrical testing were performed to confirm the position. In this series, the Micra™ VR system (model MC1VR01) was used in two cases, while the Micra™ AV system (model MC1AVR1) was used in the remaining cases (n = 8). The Micra™ delivery system was then advanced and deployed in the right ventricle “mid-septum” under fluoroscopy guidance. The Micra™ introducer system was then inserted using the right or left femoral-vein approach after gradual upscale dilation and guidewire insertion at the entry site. In this case series, no general anesthesia was used instead, light conscious sedation was pursued in nine cases, while one patient was intubated and required no further sedation.
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According to our protocol from before the start of the pandemic, all Micra™ implantation patients would undergo light conscious sedation with midazolam (Versed ® Roche Holding, Basel, Switzerland). One percent lidocaine was used to infiltrate and anesthetize the groin area. The groin was prepped in the usual sterile manner. Ten patients (six with AV block, two with symptomatic bradycardia, one with sinus node dysfunction, and one with symptomatic bradycardia and sinus node dysfunction) presented with various arrhythmias and conduction abnormalities during the COVID-19 pandemic to undergo pacemaker implantation at our institution with enhanced precaution protocols.
#Total av reviews 2019 series
Here, we present a case series of 10 patients with various conduction disease abnormalities necessitating the implantation of a right ventricle pacemaker who presented during the months of March to May 2020, which was the time of the initial peak of the COVID-19 pandemic in New Jersey. This is true even in the context of the current coronavirus disease 2019 (COVID-19) pandemic, where enhanced precautions are mandated to limit viral spread. 1Ĭertain arrhythmias and conduction abnormalities, such as high-degree atrioventricular (AV) block, necessitate urgent and timely pacemaker insertion. Due to this device’s small size and the less-invasive nature of the implantation procedure, patients receiving the Micra™ device experience fewer complications, hospitalizations, and revisions as compared with those given transvenous pacemakers. The Micra™ Transcatheter Pacing System (Medtronic, Minneapolis, MN, USA) is a fairly novel leadless intracardiac pacemaker that is implanted in the right ventricle via a femoral-vein transcatheter approach.