Is day-case surgical procedure safe for MICRA leadless pacemaker implantation?

Background: MICRA implantation is not commonly done as a day-case procedure. Elective leadless pacemakers are implanted routinely in our centre.

Objective: To assess whether the day-case MICRA procedure is safe.

Methods: We retrospectively collected data from all patients undergoing elective MICRA implantation at our centre between May 2014 and Nov 2022 (n = 81). Two patient groups were stratified: those planned to be discharged on the same day (SD, n = 52) and those planned to be observed overnight after the procedure (ON, n = 29). Patient demographics, size of the sheath used, type of MICRA device, and rate of complications were recorded. In patients with successful implants (n = 80), device function at discharge and first routine follow-up were evaluated.

Results: There were 58% males in the SD group and 45% in the ON group. Median age was 49 years in the SD and 67 years in the ON. Among patients who were planned as a day case, 8 patients had to stay in the hospital but for < 48 h: 2 due to minor groin bleeding, 1 due to patient's request despite fit to discharge, 4 due to the procedure carried out later in the day, and 1 for observation due to procedural complexity. MICRA implantation was successful in 80 patients. The rate of the major complications was 2% in the SD group and 7% in the ON group (p = 0.223), and none of the co-morbidities assessed showed an association with any complications. Device parameters at the follow-up were available in 76 patients. The rate of patients with low and stable PCT at follow-up was also 98% in the SD group and 96% in the ON group.

Conclusions: Day case MICRA procedure can be performed safely in an appropriately selected patient population.