Sole transfemoral venous access for cardiac pacemaker implantation

Description

A 46-year-old man presented to the emergency department, with dizziness and syncopes. ECG revealed a second-degree Mobitz type 2 atrioventricular-block (figure 1A). Owing to a history of thrombosis, phlebography was performed, which showed thrombosis of subclavian veins and the left brachiocephalic vein (figure 1B). Furthermore, the patient suffered from constrictive pericarditis after radiotherapy for a non-Hodgkin's lymphoma. Cardiac MRI showed complete adhesion of almost the entire free and apical right ventricular wall to the pericardium (figure 1C). Since endocardial and epicardial access were missing, an interdisciplinary heart team decided to implant a transcatheter cardiac pacemaker.

Figure 1.

(A) Twelve-lead ECG showing second-degree Mobitz type 2 atrioventricular-block. (B) Multiple thrombosis detected by phlebography. (C) Cardiac MR revealed adhesion of the right ventricle to the pericardium. (D) Fluoroscopy during implantation of the transcatheter pacemaker.

The percutaneous implantable transcatheter pacemaker (volume 0.8cc; Micra, Medtronic, Minnesota, USA) was released, via right femoral venous access, in an apical position in the right ventricle (figure 1D).^1–3 The patient was discharged on the third postoperative day. During 3 months follow-up, the patient experienced no cardiovascular-related adverse events. This case demonstrates that transcatheter pacemaker implantation is a valuable option for patients with sole transfemoral venous cardiac access.

Learning points.

• Leadless pacing is an innovative pacing approach.

• In the setting of sole transfemoral venous cardiac access, transcatheter pacemaker implantation is a valuable option.