Cautionary tale of right ventricular perforation during Micra™ leadless pacemaker insertion

Area of Science:

• Cardiology
• Medical Devices

Background:

• Transcatheter pacing systems are leadless devices designed to avoid complications associated with traditional pacing systems.
• Pre-approval trials indicated a low incidence of device-related cardiac perforation for systems like Micra™ and Nanostim.
• Post-approval data for Micra™ TPS suggested even lower major complication rates.

Purpose of the Study:

• To report two cases of major right ventricular perforation requiring surgical intervention in patients implanted with transcatheter pacing systems.
• To highlight potential serious complications associated with leadless pacing technology.

Main Methods:

• Case report of two patients who experienced major right ventricular perforation after implantation of a transcatheter pacing system.
• Review of clinical presentation, diagnostic findings, and surgical management.

Main Results:

• Both patients developed major right ventricular perforation requiring emergent surgical repair.
• These cases contrast with previously reported lower complication rates in pre-approval and post-approval studies.

Conclusions:

• While transcatheter pacing systems offer benefits, major complications such as cardiac perforation can occur.
• These findings underscore the importance of vigilance and prompt management of suspected perforations in patients with these devices.