Successful Leadless Pacemaker Implantation Despite SVC Obstruction

A 69-year-old male underwent implantation of a leadless pacemaker after a failed attempt to upgrade his single lead ICD in the setting of SVC obstruction.

A 69-year-old male with ischemic cardiomyopathy status post single chamber ICD presented with fatigue. Device interrogation revealed increased RV pacing. Device upgrade was attempted; however, he was found to have a SVC obstruction. A leadless pacemaker was subsequently placed in the right atrium via femoral approach.

Permanent leadless pacemakers provide a safe, less invasive alternative for patients with conditions that would have previously required complex interventions. Our case demonstrates the use of a leadless pacemaker in a patient with SVC obstruction and ESRD, offering lower infection risk and benefit of retrievability.