Novel atrioventricular sequential pacing approach using a transvenous atrial pacemaker and a leadless pacemaker: a
Elhosseyn Guella1, Frances Devereux1, Fozia Zahir Ahmed1,2
1Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
European Heart Journal. Case Reports
|August 11, 2021
Summary
Transvenous leads can cause tricuspid valve dysfunction. A novel dual-pacemaker approach using an AAI device and a leadless Micra AV pacemaker successfully treated severe tricuspid regurgitation after lead extraction.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Transvenous pacing leads pose a risk of tricuspid valve (TV) dysfunction, leading to tricuspid regurgitation (TR) through leaflet coaptation failure or direct damage.
- Management strategies for pacemaker implantation post-transvenous lead extraction (TLE) or TV repair aim to avoid placing new leads across the TV.
Observation:
- A 66-year-old woman with a history of dual-chamber pacemaker implantation presented with symptoms of severe lead-related TR.
- Echocardiography confirmed severe TR, prompting a multidisciplinary team discussion.
Findings:
- A successful transvenous lead extraction (TLE) was performed, followed by the implantation of a leadless Micra AV pacemaker.
- The existing atrial lead was preserved and connected to an AAI pacemaker, enabling atrioventricular (AV) synchronous pacing.
Implications:
- This case demonstrates the first successful AV sequential pacing using a dual-pacemaker strategy with an AAI device and a Micra AV leadless pacemaker.
- This approach offers a potential alternative to open-heart surgery for managing TR in patients with prior lead issues.
