Transcatheter Leadless Cardiac Pacing in Renal Failure with Limited Venous Access

Entirely leadless cardiac pacemakers that are delivered transvenously required the use of large-diameter delivery sheath and femoral venous approach. The complexity of external femoral and iliac venous anatomy may limit their implantation. We describe a hemodialysis patient without subclavian venous access and a conventional pacemaker with a failed right ventricular lead, who had difficult iliac venous anatomy that was also compressed by an external endovascular abdominal aortic stent. Successful leadless pacing using a Micra™ (Medtronic Inc., Minneapolis, MN, USA) was accomplished with a strong support wire, hydrophilic delivery sheath, and guided by venography.