Outcomes of Micra leadless pacemaker implantation with uninterrupted anticoagulation

Background Implantation of the MICRA Leadless pacemaker requires the use of a 27 French introducer, blunt delivery system and device fixation to the myocardium via nitinol tines. While prior studies have proven its safety, it is unclear whether performing this procedure with uninterrupted anticoagulation exposes patients to increased risks. We sought to investigate the feasibility and safety of continuing therapeutic anticoagulation during the periprocedural period. Methods We evaluated all patients undergoing MICRA placement at our institution between April 2014 and August 2018 with complete follow‐up data (n = 170). Patients were stratified into two groups: those on active anticoagulation (OAC, n = 26), defined as having an International normalized ratio >2.0 or having continued a direct oral anticoagulant, and those not anticoagulated (Off‐OAC, n = 144). We evaluated for a composite outcome of all major complications, including access site complications and pericardial effusion. Results OAC and Off‐OAC groups had similar mean age (74 ± 13 vs 75 ± 13 years; P = .914). The OAC group had a nonsignificantly lower prevalence of end‐stage renal disease (8% vs 17%; P = .375) and aspirin use (27% vs 47%; P = .131). Those in the OAC group were more likely to be on warfarin than those in the Off‐OAC group (81% vs 30%; P