Ventricular electrical storm after Micra™ leadless pacemaker implant

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Leadless pacemaker implantation is a growing procedure for bradycardia management.
• Peri- and post-procedural ventricular tachycardia (VT) is a rare but serious complication.
• Substrate for VT can be influenced by underlying myocardial conditions.

Observation:

• A patient developed monomorphic VT the day after leadless pacemaker implantation.
• The patient had a history of coronary artery disease with pre-existing subendocardial scarring.
• The VT was attributed to the novel ventricular activation wavefront from pacing, creating a reentrant circuit.

Findings:

• Invasive electrophysiologic study identified the VT circuit.
• Radiofrequency ablation successfully terminated the ventricular tachycardia.
• The procedure was performed safely in a patient with significant myocardial scarring.

Implications:

• This case highlights the importance of considering myocardial substrate in the context of leadless pacing.
• Electrophysiology-guided ablation is a viable and safe treatment for refractory VT post-leadless pacemaker implantation in selected patients.
• Further research into predicting and preventing VT in this population is warranted.