Temperature Sensor-Mediated Intraoperative Tachycardia in a Leadless Pacemaker During Cardiac Surgery

Leadless pacemaker use has grown with some now including temperature-based sensors rather than motion-based sensors. We present a case of unexpected rewarming-induced rapid pacing during cardiopulmonary bypass in a patient with the Aveir leadless pacemaker.

We present a case of a patient with a leadless pacemaker undergoing cardiac surgery and suffering from rapid ventricular pacing when weaning from bypass treated by applying a magnet to stop rapid pacing with device interrogation conducted intraoperatively. The rate response feature was disabled with the patient weaned from bypass.

Traditional pacemakers use rate response features whereas the Aveir leadless pacemaker uses a temperature-based response feature. For this reason, the device is susceptible to inappropriate pacing when patients undergo rewarming during cardiac surgery resulting in possible hemodynamic compromise.

Patients undergoing cardiac surgery with leadless pacemakers in place should have a careful preoperative evaluation with the rate response feature turned off before surgery if indicated.