EuroPCR Panel Reviews Advances in Complex Cardiovascular Interventions

May 21, 2014—New technological advances, such as leadless cardiac pacing and the latest generation of transcatheter heart valves, were discussed at a session organized by the European Heart Rhythm Association (EHRA) and the European Association for Percutaneous Cardiovascular Interventions (EAPCI) at EuroPCR 2014 in Paris, France. EuroPCR is the official annual meeting of the EAPCI, a registered branch of the European Society of Cardiology (ESC).

As summarized by EuroPCR’s press release, the discussions featured the Nanostim (St. Jude Medical, Inc.) and the Micra (Medtronic, Inc.) single-chamber leadless pacing systems and the Edwards Sapien 3 transcatheter heart valve (Edwards Lifesciences).

With regard to leadless pacing, it was noted that there was a need for a novel system that provides reliable pacing and sensing, and addresses the challenges of current pacing systems by minimizing the risks of infection, pneumothorax, dislodgement, and long-term infection.

Prof. Panos Vardas, MD, stated, “The two different technologies, leadless pacemakers and the new generation valves, reflect the progress seen within interventional cardiology and electrophysiology. In the case of the leadless pacemaker, advances in the longevity of the battery of the devices, which are now expected to last 7 to 10 years, have been a most important advancement.” Prof. Vardas, who is from the University Hospital of Crete, Greece, is President of the ESC and a past President of EHRA.

Prof. Karl Heinz Kuck, MD, of St. George Hospital in Hamburg, Germany, and President of EHRA, then commented on a video demonstrating the implantation of the leadless technology and informed delegates about the status of the early clinical evidence in the field of leadless pacing. Prof. Kuck commented, “The technical advancement with leadless pacemakers represents a big step forward. These devices have the advantage of a reduced risk of infection and also a significantly lower risk of thromboembolic complications that may lead to pulmonary hypertension. The only uncertainties that we currently face are due to the fact that the experience with the device is still rather limited, and we are yet to identify the best position to have a safe implantation. My personal view is that we need better imaging technology during the implant to guarantee that the device goes to the septum and not to the free wall.”

Prof. Vardas added, “Leadless pacing is a very significant development, but to take it from the current VVIR configuration to the next stage of double-chamber pacing is going to be a challenge. Also, we need longer follow-up, and a better understanding of the thrombogenicity of the devices and possible complications, but I am optimistic that progress is underway.”

Participants also saw an interactive live transmission of a complete implantation of the Edwards Sapien 3 valve in approximately 40 minutes, performed by Prof. Stephan Windecker, MD, and a team from Bern University Hospital in Bern, Switzerland. The expert panel noted that advancements in valve technology had significantly impacted the incidence of severe paravalvular leak, with no reported cases of severe leak with these devices.