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Related Experiment Video

Updated: Nov 1, 2025

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Ventricular electrical storm after Micra™ leadless pacemaker implant.

Bert Vandenberk1, William Lee2, George Veenhuyzen3

  • 1Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.

Journal of Electrocardiology
|June 17, 2021
PubMed
Summary

Ventricular tachycardia (VT) after leadless pacemaker implantation is rare. Electrophysiology study and ablation successfully treated VT in a patient with prior heart scarring, demonstrating a safe strategy for selected cases.

Keywords:
Cardiac ablationCardiomyopathyComplicationLeadless pacemakerVentricular electrical storm

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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.