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Case Report: A leadless and endovascular pacemaker teamwork.

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|November 29, 2023
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Summary
This summary is machine-generated.

Leadless pacemakers combined with atrial pacing effectively manage AV block in high-risk patients with lead dysfunction, maintaining AV synchrony and improving quality of life.

Keywords:
atrioventricular synchronydevice infectionendovascular pacemakerlead dysfunctionleadless pacemaker

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Area of Science:

  • Cardiology
  • Biomedical Engineering

Background:

  • Cardiac Implantable Electronic Device infections pose significant mortality and cost risks.
  • Leadless pacemakers (PM) aim to reduce lead-related complications.
  • Advancements allow leadless devices to support atrioventricular (AV) synchronous stimulation.

Observation:

  • A 90-year-old woman with prior dual-chamber pacemaker developed complete AV block due to ventricular lead dysfunction.
  • She received a leadless PM (MICRA™) for VDD mode pacing due to high infection risk.
  • The existing pacemaker was programmed for atrial pacing, triggering the leadless PM for ventricular pacing.

Findings:

  • This combined approach successfully maintained AV synchrony in 85% of cases at six months.
  • The strategy mitigated risks associated with lead-related complications and infection.
  • Successful AV synchrony was achieved by programming the atrial pacemaker to drive the leadless ventricular pacemaker.

Implications:

  • Combining atrial pacing with leadless ventricular pacing is a viable strategy for high-risk patients with lead dysfunction.
  • This approach can maintain AV synchrony, improving hemodynamic function and patient quality of life.
  • Adequate AV synchrony requires low resting sinus rate variability.