3 Leadless Pacemaker Implantations in an 81-Year-Old Woman With a History of Transvenous Pacemaker Infection

Leadless pacemakers (LPMs) offer an alternative for patients with challenging venous access or device infection history. Management of LPM battery depletion in frail patients presents unique challenges. We present the case of an 81-year-old frail woman with obstructive hypertrophic cardiomyopathy and complete heart block, previously treated with percutaneous transseptal myocardial ablation and a transvenous pacemaker, who received an LPM after device extraction for infection. On battery depletion, a second LPM was implanted but dislodged, thus necessitating extraction attempts. Given the high extraction risks, a third LPM was successfully implanted. This case highlights the feasibility of multiple LPM implantations in complex cardiac patients and demonstrates that a third LPM can be a viable option when extraction risks are high. This approach expands management options for frail patients with complex cardiac histories who are unsuitable candidates for traditional pacing systems.