Revolutionization of the Leadless Pacemaker Implantation: Hemodynamic Verification Slashes Vascular Complications.

Background: The procedure of implanting a Micra leadless pacemaker (Medtronic PLC, Dublin, Ireland) via transfemoral venous access carries the risk of vascular complications. Our study examined whether Liu's hemodynamic verification technique, a basic bedside evaluation of flow and pulsatility through the sheath side port before dilator advancement, minimizes vascular complications in Micra implantation. Methods: We conducted a retrospective analysis of 465 consecutive Micra implantations performed at the Department of Cardiology, West China Hospital of Sichuan University, from December 2019 to November 2023. Participants were categorized into two groups: Group A (n = 389), which employed pre-dilation hemodynamic verification with sheath blood flow analysis (Liu's method), and Group B (n = 76), which used standard vascular access. The groups were compared based on demographics, procedural specifics, and vascular complications. Results: Compared with the standard puncture method, Liu's technique was linked to a much lower incidence of vascular complications (0.5% vs. 3.9%; Conclusion: In this single-center retrospective study of 465 consecutive Micra implantations, Liu's method for hemodynamic verification significantly reduced the rate of vascular complications and completely prevented major vascular events compared with traditional femoral venipuncture. The technique is straightforward, economical, easy to learn, and could be a viable option when ultrasound guidance is not accessible.