Transthoracic Echocardiography-Guided Implantation of Aveir VR Leadless Pacemaker Without Fluoroscopy.

BACKGROUND: Leadless pacemaker implantation traditionally relies on fluoroscopy and contrast-guided techniques. However, in patients with advanced chronic kidney disease, the use of contrast carries a risk of nephrotoxicity, and fluoroscopy leads to additional ionizing radiation exposure. CASE SUMMARY: We report a case of a 69-year-old man with occasional sinus arrest and end-stage renal disease on hemodialysis who successfully underwent implantation of an Aveir VR leadless pacemaker (Abbott, USA) entirely under transthoracic echocardiographic (TTE) guidance, without fluoroscopy or contrast. Using a Philips EPIQ system with an X5-1 transducer, key procedural steps-including navigation, septal positioning, pacing threshold testing, and final deployment-were completed under real-time ultrasound visualization. Post-procedural pacing parameters were optimal, and no complications occurred. Chest radiography confirmed appropriate device position. CONCLUSION: This case demonstrates the potential feasibility and safety of an ultrasound-guided implantation technique for the Aveir VR leadless pacemaker. It may offer a promising alternative for patients with contraindications to radiation or contrast agents. Larger studies are needed to validate and standardize this approach.