Key result
Intraoperative right atrial imaging may improve leadless pacemaker placement via Thebesian vein visualization for AV synchrony.
Why the study?
Dual-chamber leadless pacing requires careful anatomical assessment for atrial capsule positioning, with limited data on intraoperative imaging to guide implantation strategy.
Case Report (n=1)
Intraoperative right atrial imaging can identify anatomical variants like a prominent Thebesian vein to guide optimal positioning of an atrial leadless pacemaker and restore AV synchrony.
Answers are grounded in this paper and cite their sources.
May warrant intraoperative right atrial imaging during leadless pacemaker implantation; hypothesis-generating for improved AV synchrony.
BACKGROUND: Dual-chamber leadless pacing is an emerging technology that demands careful anatomical assessment, particularly for atrial capsule positioning. CASE SUMMARY: A 66-year-old woman with prior mediastinal radiotherapy and bilateral breast cancer presented with complete atrioventricular (AV) block. A ventricular AVEIR leadless pacemaker was initially implanted with stable electrical parameters. Because of exertional dyspnea suggestive of AV dyssynchrony, an atrial AVEIR right atrial capsule was subsequently added. Intraoperative right atrial angiography revealed a prominent Thebesian vein, prompting capsule implantation in a posterolateral position. This approach enabled effective AV synchrony, resulting in a rapid symptomatic improvement. DISCUSSION: This case report underscores the importance of intraoperative imaging to identify anatomical variants that may affect leadless pacemaker implantation. It also supports the clinical relevance of restoring AV synchrony in selected patients initially treated with single-chamber pacing. TAKE-HOME MESSAGES: Intraoperative right atrial imaging enhances leadless device placement. AV synchrony restoration may offer significant symptomatic benefit.
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Morgat et al. (2026) conducted a case report in Complete atrioventricular (AV) block (n=1). Atrial AVEIR right atrial capsule implantation guided by intraoperative right atrial angiography was evaluated on Symptomatic improvement and effective AV synchrony. Intraoperative right atrial angiography identified a prominent Thebesian vein, guiding successful posterolateral implantation of an atrial leadless pacemaker and restoring AV synchrony.
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