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First Reported Case of Infection Involving a Leadless Atrial Pacemaker
Sadichhya Karki1, Mark Metzl2, Jonathan Rosenberg3
1Division of Cardiology, University of Chicago-NorthShore, Evanston, Illinois, USA.
Background:
Leadless pacemakers were developed to reduce infection risk compared with transvenous systems. However, real-world data on device-related infections in newer models like the leadless atrial pacemaker (AVEIR AR) remain limited.
Case Summary:
A 70-year-old man with atrial fibrillation and prior methicillin-resistant Staphylococcus aureus (MRSA) pacemaker infection presented with acute respiratory failure and MRSA bacteremia 3 months after implantation of the leadless atrial pacemaker. Imaging showed a cystic mass attached to the device. The pacemaker was percutaneously extracted under intracardiac echocardiography guidance. Persistent bacteremia prompted aspiration of the residual mass using a percutaneous aspiration device (AlphaVac system). Cultures confirmed MRSA.
Discussion:
This represents the first documented case of endocarditis involving a leadless atrial pacemaker system. Although leadless pacemakers are designed to minimize infection, they are not immune to serious complications.
Take-Home Messages:
Leadless pacemakers can still develop infections. Percutaneous aspiration-guided removal is a feasible management option. Prompt recognition and intervention are essential.
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