Implantation of Leadless Pacemaker in a Patient With Chronic Type A Aortic Dissection-A Case Report

When implanted into a structurally normal heart, leadless pacemakers are more effective and safer than traditional pacemakers. However, clinical experience with leadless pacemaker implantation in patients with severe right heart deformity remains limited. We present a rare case of an 87-year-old woman with right heart deformity (secondary to chronic Stanford type A aortic dissection) who successfully underwent implantation of a Micra leadless pacemaker. Preoperative computed tomography (CT) revealed compression of the right atrium by an ascending aortic root dissection aneurysm (maximum diameter: 7.2 cm) and clockwise rotation of the right heart. The delivery system was adjusted repeatedly during the operation, and angiography confirmed that the delivery system was in the right ventricle before releasing the pacemaker. Preoperative familiarity with distorted cardiac anatomy (via CT) and intraoperative angiographic verification of delivery system location are critical for safe leadless pacemaker implantation in patients with right heart deformity. These measures can effectively prevent complications such as cardiac perforation.