Key result
Leadless pacemaker implantation linked to vascular complications leading to high output heart failure.
Why the study?
Leadless pacemakers have a higher risk of vascular complications, including rare but serious events like arteriovenous fistula leading to high output heart failure.
Case Report (n=1)
Leadless pacemaker implantation can be complicated by arteriovenous fistula formation at the access site, potentially leading to high output heart failure.
Answers are grounded in this paper and cite their sources.
Clinicians should monitor for high-output HF after leadless pacemaker implantation; hypothesis-generating and requires larger studies to define incidence.
BACKGROUND: Leadless pacemakers have a significantly higher risk of vascular complications than traditional transvenous devices. CASE SUMMARY: An 85-year-old man with permanent atrial fibrillation presented with symptomatic bradycardia. A leadless pacemaker was implanted, and the procedure was complicated by a right common femoral vein pseudoaneurysm which was treated with thrombin injection. Months later, he presented with worsening volume overload related to high output heart failure from an arteriovenous fistula at the access site. After surgical repair of his fistula, the patient had resolution of heart failure. DISCUSSION: Arteriovenous fistula is a relatively rare complication of cardiac catheterization, but its risk is increased with procedures like leadless pacemaker insertion. Such procedures require a larger caliber sheath, which is associated with a significantly higher risk of vascular complications. TAKE-HOME MESSAGES: Leadless pacemakers have a unique set of associated vascular complications that could lead to significant adverse outcomes.
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Khasawneh et al. (2026) conducted a case report in Permanent atrial fibrillation with symptomatic bradycardia (n=1). Leadless pacemaker implantation was evaluated on High output heart failure from an arteriovenous fistula. Leadless pacemaker implantation in an 85-year-old man was complicated by an arteriovenous fistula at the access site, leading to high output heart failure that resolved after surgical repair.
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