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Case Reports
. 2022 Dec 12;7(1):ytac474.
doi: 10.1093/ehjcr/ytac474. eCollection 2023 Jan.

Synchronous atrioventricular sequential pacing utilizing conventional and leadless pacemakers in an elderly patient: a case report

Neil Bodagh  1 , Kevin Cheng  2 , William Eysenck  2 , Tom Wong  2
Affiliations
Case Reports

Synchronous atrioventricular sequential pacing utilizing conventional and leadless pacemakers in an elderly patient: a case report

Neil Bodagh et al. Eur Heart J Case Rep. .

Abstract

Background: Leadless pacemakers present a viable alternative to conventional transvenous devices to mitigate the risk of lead- and/or pocket-related complications. In elderly patients who have encountered ventricular lead failures with transvenous pacemakers, this option may enable the delivery of atrioventricular synchronous pacing therapy, while obviating the requirement for lead extraction and lead-based pacemaker re-implantation.

Case summary: This case report describes the successful implantation of a leadless pacemaker in a 90-year-old who had undergone two dual-chamber permanent pacemaker implantation procedures with a failure of three of four previously implanted leads. Atrioventricular synchronous pacing was achieved, as the leadless device was able to track the atrial-paced rhythm from the pre-existing right-sided device.

Discussion: In elderly patients who have encountered issues with transvenous pacemakers, alternative approaches should be considered to mitigate the risk of future complications. Leadless pacemakers may offer a low-risk solution, enabling the delivery of atrioventricular synchronous pacing therapy in such patient groups. Future studies should be designed to delineate whether these devices could be utilized as a first-line approach in certain situations.

Keywords: Bradycardia; Case report; Lead failure; Leadless pacemaker.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Electrocardiogram rhythm strip exhibiting a complete heart block.
Figure 2
Figure 2
Chest X-ray following external pacemaker implantation demonstrating the presence of five right-sided leads (two leads from the left-sided device, two leads from the right-sided device, and one lead from the external pacemaker).
Figure 3
Figure 3
Fluoroscopic view demonstrating the final position of the leadless pacemaker in the right ventricular septum.
Figure 4
Figure 4
Electrocardiogram post leadless pacemaker insertion demonstrating atrioventricular sequential pacing, as the leadless pacemaker was able to track the atrial-paced rhythm from a pre-existing device.
Figure 5
Figure 5
(A) Pacing system analysis demonstrating atrial mechanical sensing and atrioventricular synchronous pacing. (B) Micra atrioventricular leadless pacemaker histogram.
See this image and copyright information in PMC

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