To evaluate the feasibility and safety of a sequential leadless-only pacing strategy in a patient with a multi-decade history of pacing-related complications and recurrent device-associated infections.
Approach:
Patient Background: A 65-year-old patient with a 26-year history of cardiac pacing and recurrent device-related infections transitioned from a depleted first-generation leadless pacemaker to an AV-synchronous leadless pacemaker using a leave-in-situ approach.
Key Findings:
Sequential implantation was successfully performed with satisfactory acute electrical parameters (pacing threshold 0.63 V, R-wave amplitude 9.8 mV, impedance 720 Ω).
No evidence of inappropriate sensing or device-related complications was observed during follow-up.
Electrical parameters remained stable at follow-up, with atrioventricular synchrony of 80% at 1 month and 84-85% at 3-6 months.
Interpretation:
A sequential leadless-only pacing strategy may represent a feasible and safe long-term option in selected high-risk patients with device-related infections.
Limitations:
Limited clinical data on long-term management and sequential implantation strategies after battery depletion, particularly in the context of device-related infections.
The study is based on a single patient case, limiting generalizability.
Conclusion:
The sequential leadless-only pacing strategy may be a potential option for patients with a history of device-related infections.
