Heart complications are part of the natural history of Duchenne muscular dystrophy (DMD), especially in adulthood, where they are responsible for a significant number of deaths. Besides cardiomyopathy related to fibrotic degeneration of the myocardial tissue, heart rhythm disorders and, especially, conduction disorders, represent clinical situations that are critical and not uncommon, and that can lead to the indication of a pacemaker in certain patients. Conventionally, this is implemented in the form of an intraventricular pacing catheter connected to a housing implanted under the skin. In fragile patients, the implantation of such a medical device is not free of surgical risk, especially risk of an infectious, bleeding and ventilatory (pneumothorax) nature.
In an article published in June 2021, the team at the Garches Neuromuscular Reference Centre described a procedure that constituted a first in their practice, the implantation of a very small pacemaker developed by Medtronics (Medtronic Micra®). This next-generation pacemaker, the size of a one euro coin, was successfully implanted in a 38-year-old patient with DMD, after catheterisation of the femoral vein. It does not use a catheter; that is precisely its benefit, and it is in direct contact with the right ventricular myocardial wall. The post-operative course was simple and a follow up over 20 months did not identify any particular complications.
