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Updated: Oct 15, 2025

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Difficulty removing a leadless pacemaker in a post-transfusion patient.

Atomu Tajima1,2, Yoshiaki Mizutani3, Masaaki Kanasiro1

  • 1Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Japan.

BMJ Case Reports
|October 28, 2021
PubMed
Summary

A 99-year-old patient experienced clot formation on a leadless pacemaker tether following a blood transfusion that induced hypercoagulability. This highlights a potential risk during leadless pacemaker procedures in anemic patients receiving transfusions.

Keywords:
arrhythmiaspacing and electrophysiology

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Area of Science:

  • Cardiology
  • Hematology

Background:

  • Leadless pacemakers offer a minimally invasive option for bradycardia management.
  • Anemia is common in elderly patients and may necessitate blood transfusions.

Observation:

  • A 99-year-old woman with atrial fibrillation and bradycardia received a red blood cell transfusion for anemia prior to leadless pacemaker implantation.
  • Post-transfusion blood tests revealed significant hypercoagulability, with elevated hematocrit, hemoglobin, and fibrinogen levels.
  • Clot formation on the pacemaker tether complicated its removal after implantation.

Findings:

  • Transfusion-induced hypercoagulability, not hereditary disorders, was observed in this patient.
  • The elevated fibrinogen and hematocrit levels likely contributed to clot formation on the pacemaker tether.
  • Difficulty in tether removal due to clots indicates a potential procedural complication.

Implications:

  • Transfusion-induced hypercoagulability should be considered as a risk factor in patients undergoing leadless pacemaker implantation.
  • Careful monitoring of coagulation parameters post-transfusion may be warranted in this patient population.
  • Further research is needed to elucidate the precise mechanisms and clinical significance of this phenomenon.