Simultaneous leadless pacemaker and subcutaneous implantable cardioverter-defibrillator implantation-When vascular...

Area of Science:

• Cardiology
• Medical Devices
• Nephrology

Background:

• Patients with end-stage renal failure often require cardiac devices.
• Vascular access is crucial for device implantation.
• Venous occlusions can complicate standard device implantation procedures.

Observation:

• A patient with end-stage renal failure and complete heart block required both a pacemaker and an implantable cardioverter-defibrillator.
• The patient had a right subclavian venous occlusion, precluding standard device implantation.
• A left brachioaxillary arteriovenous graft was planned, but vascular access was limited.

Findings:

• A subcutaneous implantable cardioverter-defibrillator (S-ICD) and a leadless pacemaker were successfully implanted.
• No device interactions were observed during implantation, defibrillation testing, or after appropriate defibrillation therapy.
• This approach provided a viable alternative for cardiac device implantation in the presence of venous occlusion.

Implications:

• S-ICDs and leadless pacemakers can be safely implanted in patients with complex venous anatomy.
• This case highlights the feasibility of alternative implantation strategies when standard venous access is compromised.
• These device options expand treatment possibilities for patients with renal failure and cardiac conditions.