{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:20:01Z","timestamp":1784546401005,"version":"3.55.0"},"reference-count":11,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,7,4]],"date-time":"2021-07-04T00:00:00Z","timestamp":1625356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["KAKENHI JP19K20724"],"award-info":[{"award-number":["KAKENHI JP19K20724"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["KAKENHI JP20K17143"],"award-info":[{"award-number":["KAKENHI JP20K17143"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Leadless pacemakers are less invasive but are as effective as conventional pacemakers and are increasingly implanted in elderly patients. However, the implantation procedure is sometimes challenging in patients with abnormal anatomy, particularly those with an enlarged right heart. We aimed to determine the right heart parameters that were associated with longer procedure times for leadless pacemaker implantation. Materials and Methods: Among 19 consecutive patients in whom Micra leadless pacemakers (Micra TPS, Medtronic, Minneapolis, MN) were implanted, the diameter and area of both the right atrium and right ventricle were measured by transthoracic echocardiography before the procedure. The right heart parameters that were associated with a procedure time &gt; 60 min were investigated. Results: In the 19 patients (median 81 years old, 10 male) who underwent implantation of the Micra system, 6 (32%) required a procedure time &gt; 60 min. Among the baseline right heart echocardiographic parameters, right atrial diameter and area were significantly associated with a procedure time &gt; 60 min (odds ratio 11.3, 95% confidence interval 1.09\u20131.17, p = 0.042; and odds ratio 1.57, 95% confidence interval 1.05\u20132.34, p = 0.029, respectively) at a cutoff of 4.0 cm and 17.0 cm2, respectively. Conclusions: Patients with an enlarged right atrium may not be good candidates for leadless pacemakers given the longer procedure time, and conventional pacemakers should perhaps be recommended as an alternative.<\/jats:p>","DOI":"10.3390\/medicina57070685","type":"journal-article","created":{"date-parts":[[2021,7,4]],"date-time":"2021-07-04T22:34:36Z","timestamp":1625438076000},"page":"685","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Large Right Heart Is Associated with the Prolongation of the Procedure Time of Leadless Pacemaker Implantation"],"prefix":"10.3390","volume":"57","author":[{"given":"Naoya","family":"Kataoka","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7294-7637","authenticated-orcid":false,"given":"Teruhiko","family":"Imamura","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahisa","family":"Koi","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9747-2511","authenticated-orcid":false,"given":"Hiroshi","family":"Ueno","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichiro","family":"Kinugawa","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/j.jacep.2020.08.021","article-title":"Tine-based leadless pacemaker: Strategies for safe implantation in unconventional clinical scenarios","volume":"6","author":"Okabe","year":"2020","journal-title":"Clin. Electrophysiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.hrthm.2017.01.035","article-title":"Long-term performance of a transcatheter pacing system: 12-Month results from the Micra Transcatheter Pacing Study","volume":"14","author":"Duray","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1056\/NEJMoa1511643","article-title":"A leadless intracardiac transcatheter pacing system","volume":"374","author":"Reynolds","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1056\/NEJMoa1507192","article-title":"Percutaneous implantation of an entirely intracardiac leadless pacemaker","volume":"373","author":"Reddy","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.hrthm.2017.05.017","article-title":"A leadless pacemaker in the real-world setting: The Micra Transcatheter Pacing System Post-Approval Registry","volume":"14","author":"Roberts","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Imamura, T., Koi, T., Kataoka, N., Tanaka, S., Ueno, H., and Kinugawa, K. (2020). Micra trans-catheter leadless pacemaker implantation in a patient with large right heart. J. Cardiol. Cases, in press.","DOI":"10.1016\/j.jccase.2021.02.015"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.hrcr.2018.11.011","article-title":"Successful leadless pacemaker deployment in a patient with challenging right heart anatomy using a double snare technique","volume":"5","author":"Alyesh","year":"2019","journal-title":"HeartRhythm Case Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/j.hrthm.2018.08.005","article-title":"Updated performance of the Micra transcatheter pacemaker in the real-world setting: A comparison to the investigational study and a transvenous historical control","volume":"15","author":"Clementy","year":"2018","journal-title":"Heart Rhythm"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/pace.13933","article-title":"Determinants of the difficulty of leadless pacemaker implantation","volume":"43","author":"Garweg","year":"2020","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.jacep.2017.07.014","article-title":"Implantation of a MICRA leadless pacemaker via right internal jugular vein","volume":"4","author":"Kolek","year":"2018","journal-title":"JACC Clin. Electrophysiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/7\/685\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:25:52Z","timestamp":1760163952000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/7\/685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,4]]},"references-count":11,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["medicina57070685"],"URL":"https:\/\/doi.org\/10.3390\/medicina57070685","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,4]]}}}