Combined Lead Extraction and Leadless VDD Pacemaker Implantation in d-TGA Patient After Senning Procedure

BACKGROUND: Conduction abnormalities are common long-term sequelae after the Senning procedure for dextro-transposition of the great arteries (d-TGA), often requiring permanent pacing. Infection or lead malfunction may necessitate system extraction. Leadless pacemakers offer a promising alternative option. CASE SUMMARY: We present a 30-year-old man with d-TGA who previously underwent a Senning procedure. He had an infected pacemaker with lead extrusion. A combined procedure was performed, including complete system extraction and implantation of a leadless VDD pacemaker (Micra AV2). The procedure achieved atrioventricular (AV) synchrony and rapid recovery. DISCUSSION: This case highlights the viability of integrating leadless VDD pacemaker implantation with lead extraction in post-Senning d-TGA patients for efficient AV synchrony. It supports leadless pacing as practical solution for complex congenital cardiac anatomy. TAKE-HOME MESSAGES: Leadless pacemakers represent a promising alternative pacing strategy for patients with d-TGA post-Senning procedure. Micra VDD pacing with AV synchrony represents an innovative and effective approach in this setting.