Leadless Pacemaker Pitfalls: Navigating Implantation and Postprocedure Challenges

Leadless pacemakers (LPs) are implanted into the right ventricular septum, eliminating intravascular complications associated with traditional pacemakers. They attach to the myocardium using 4 curved, self-expanding nitinol tines.

Our case highlights the rare occurrence of LP dislodgement into the pulmonary artery and the delayed development of a traumatic right ventricular apical pseudoaneurysm.

LPs were designed to reduce the lead- and pocket-related complications that can be seen with conventional pacemakers. However, LPs carry a risk of dislodgement and embolization into the pulmonary artery compared with conventional pacemakers.

This case explores the complexities and risks involved in both the implantation and retrieval of LPs in high-risk patient populations and highlights the importance of meticulous technique in retrieving an acutely embolized LP from the right PA.