Leadless pacemaker implantation in a patient with complex congenital heart disease and limited vascular access

Abstract

Management of rhythm related issues might be particularly challenging in patients with congenital heart disease due to complex anatomy and restricted vascular access. The leadless technology appears a suitable and attractive alternative for this population. We describe a patient with single ventricle physiology who successfully underwent implantation of a leadless pacemaker.

Systemic ventricular implantation of a leadless pacemaker in a patient with a univentricular heart and atrioventricular node calcification

“…The use of multiple imaging modalities may guide safe pacemaker implantation and was recently advised in a case report by Ferrero and colleagues. 2 In our patient, TOE provided visual and spatial awareness, which was crucial to the success of the implant.…”

“…1 Minimal data exists on the use of the Micra system in patients with congenital heart disease, with only 1 reported case in a patient with single-ventricle physiology. 2,3 We present a patient with Ebstein anomaly, palliated with a Blalock-Taussig shunt, who developed late-onset complete heart block secondary to atrioventricular node calcification (Figure 1). He was managed with leadless pacemaker implantation into the systemic ventricle.…”

Leadless pacemaker implantation via azygos vein in a patient with absence of the hepatic segment of the inferior vena cava

“…Difficult iliac venous access caused by an external endovascular abdominal aortic stent, and abnormal venous anatomy in a complex congenital heart disease have been previously described in LPM implantation. 2,3 This is the first report of a successful LPM in a patient with an enlarged and tortuous azygos vein. We believe that this may contribute to the use of this technique in patients with difficult and limited vein anatomy who require pacemaker implantation.…”

Successful leadless pacemaker deployment in a patient with challenging right heart anatomy using a double snare technique

“…While there has been a report of successful implantation of leadless pacemaker technology in challenging congenital anatomy, to our knowledge this case is the first successful Micra TPS deployment in challenging right heart anatomy, where external snares provided critical added reach 2 . The loop snare–on–catheter shaft technique we employed is easily reproducible and could be safely and successfully replicated at other centers with readily available equipment.…”