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Leadless Pacemaker Dysfunction From Interference by a Retained Transvenous Pacemaker With Active Minute Ventilation
Faisal Naffa'1, Binaya Basyal2, Cyrus Hadadi2
1Internal Medicine, MedStar Health Georgetown University, Baltimore, Maryland, USA.
Background:
Leadless pacemakers reduce complications of transvenous leads. However, interactions between leadless pacemakers and retained transvenous cardiac implantable electronic devices remain an underrecognized issue.
Case Summary:
A 72-year-old woman with complete heart block underwent dual-chamber pacemaker implantation in 2004 and generator changes and right ventricular lead revision in 2013 for fracture. In 2024, due to lead noise during isometric exercise and concern for lead integrity, leadless pacemaker was implanted without extracting existing system per patient preference. Postimplant the patient reported fatigue and exertional dyspnea initially attributed to COVID-19 or chronotropic incompetence. Device interrogation showed only 9% implant-to-implant (i2i) communication suggesting impaired atrioventricular synchrony. Further evaluation revealed interference from a retained Boston Scientific pacemaker with an active minute ventilation sensor. Deactivation of the sensor restored i2i communication and resolved symptoms.
Discussion:
To our knowledge, this is the first reported case of atrioventricular asynchrony specifically resulting from impaired i2i communication in a leadless pacemaker due to interference from a minute ventilation sensor.
Take-Home Message:
Comprehensive pre-implantation assessment of cardiac devices is essential to prevent device-device interactions and ensure safe leadless pacemaker function.
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