Concomitant Aveir AR and Micra AV2 Hybrid Leadless Implantation During Infected Pacemaker Extraction

Leadless pacing is an important option for patients with device-related infections. In those requiring dual-chamber support, reduced atrial battery longevity due to continuous implant-to-implant (i2i) communication remains a concern. While recent software updates now allow for the disablement of i2i communication when clinically appropriate, this mode does not provide atrioventricular synchronous pacing. We describe a case of a hybrid leadless system combining an atrial leadless pacemaker (Aveir AR, Abbott) and a second leadless pacemaker capable of atrial mechanical-sensed ventricular pacing (Micra AV2, Medtronic) in the setting of extraction of an infected transvenous pacemaker, providing atrial pacing with ventricular backup capability while preserving atrial device longevity.