Temporary use of leadless pacemaker as a bridge to cardiac resynchronisation therapy: a case report of fulminant myocarditis

Fulminant myocarditis can result in persistent severe left ventricular dysfunction and complete atrioventricular block (AVB), necessitating cardiac resynchronisation therapy (CRT). However, direct CRT implantation can be sometimes challenging in the context of intensive mechanical circulatory support and systemic steroid therapy, where the risks of procedure-related bleeding and infection are significantly heightened.

This report describes a 64-year-old woman with fulminant myocarditis, severe left ventricular dysfunction, and persistent complete AVB, who was initially managed with extracorporeal membrane oxygenation and the Impella 5.5, along with temporary pacing. Due to the high risks of infection and bleeding, we implanted a leadless pacemaker (Micra AV system) as a temporary measure prior to CRT. Following Micra AV implantation, temporary pacing was successfully removed, and signs of infection and bleeding tendency improved. CRT was subsequently implanted, and Impella 5.5 was successfully weaned.

This case underscores the potential utility of a leadless pacemaker as a bridge to CRT therapy in patients with high risks of bleeding and infection. By employing this approach, the patient's clinical condition can be optimized, enabling the safe implantation of CRT. Further studies are warranted to validate our findings and evaluate the applicability of our novel strategy.