Sudden Micra VR Battery Failure With Telemetry Loss and Fluoroscopic Battery Deformation

Leadless pacemakers rarely exhibit intrinsic device failure. A Micra VR was implanted in a 68-year-old man with persistent atrial fibrillation and complete atrioventricular block. Four years later, despite a projected 7-year longevity, pacing abruptly ceased and telemetry was lost. Fluoroscopy showed stable position but new battery-pack expansion, consistent with an abrupt battery event. A Micra AV2 was implanted; high mid-to-lower septal thresholds improved after switching to right internal jugular access for higher septal placement. The malfunctioning Micra VR was percutaneously retrieved. This case illustrates sudden Micra VR battery failure and underscores the value of fluoroscopy, follow-up, and remote monitoring.