Leadless Pacemaker for Sinus Pauses and Syncope in Pregnancy: A Feasible Alternative to Conventional Pacing

Bradyarrhythmias with syncope during pregnancy present a complex and multifaceted challenge for both patients and health care providers. When device implantation is indicated for bradyarrhythmia-associated syncope during pregnancy, the procedure should be performed with particular attention to minimizing fluoroscopy exposure to ensure maternal and fetal safety. A 29-year-old woman at 15 weeks of gestation with sinus pauses presented with recurrent syncopal episodes. The patient underwent Micra™ AV leadless pacemaker implantation (Medtronic, Minneapolis, MN, USA) with a radiation exposure of 26.5 mGy and a total fluoroscopy time of 2 min, which is generally considered a negligible dose during pregnancy, based on the recommendations of the National Council on Radiation Protection and Measurements. In pregnant patients, a leadless pacemaker may offer a viable alternative to conventional pacing, primarily due to its reduced radiation exposure, shorter procedure time, minimally invasive approach, absence of transvenous leads, and lower risk of site infection.