Transjugular Leadless Pacing in Massive Biatrial Dilation: A Straight Path to the Heart

Permanent pacing in patients with severe tricuspid regurgitation (TR) and distorted right heart anatomy is challenging, particularly when future valvular intervention is likely.

A 75-year-old man with permanent atrial fibrillation, prior mitral valve repair, massive biatrial enlargement, severe secondary TR, and symptomatic bradycardia with chronotropic incompetence required permanent pacing. Because conventional transvenous lead implantation was expected to be technically difficult and potentially unfavorable in the setting of severe TR and possible future valve intervention, a leadless pacemaker was selected. Owing to extreme atrial enlargement and altered right heart geometry, implantation was performed via the right internal jugular vein to improve catheter control and facilitate septal deployment. The procedure was successful, and pacing parameters remained stable at 8-week follow-up.

Leadless pacing avoided a transvalvular lead and preserved future tricuspid treatment options.

Leadless transjugular pacing is a useful option in patients with distorted anatomy who may require future valvular repair.