Transjugular Leadless Pacemaker in a Preschool Child With Nickel-Titanium Allergy

Leadless pacemakers (L-PMs) have limited clinical application in low-weight young pediatric patients. Conventional transvenous pacemakers carry infection/allergy risks, with no established L-PM implantation protocols for metal-allergic pediatric populations.

A 4-year-old child with third-degree atrioventricular block had previously undergone 3 failed transvenous pacemaker implantations, each complicated by poor incisional healing and skin ulceration of the subcutaneous pockets. Patch testing confirmed metal allergy. A leadless single-chamber pacemaker (Micra VR, Medtronic) was successfully implanted via the right internal jugular vein.

Pediatric metal allergy to pacemaker casings is rare, and conventional pacing is unfeasible in such cases. Literature on transjugular L-PM implantation in low-weight children with nickel-titanium allergy is scarce, with no standardized venous access or procedural approaches reported.

Transjugular L-PM implantation is a viable alternative for low-weight pediatric patients with pacemaker metal allergy and failed conventional pacing, providing a critical technical pathway for this high-risk population.