Snare‐Assisted Flexion of 27‐French Leadless Pacemaker Delivery Sheath: A Case Report

INTRODUCTION: A leadless pacemaker (LLPM) was recommended for a patient with intermittent complete heart block and near-syncope. METHODS AND RESULTS: Delivery of LLPM is through a large sheath that has limited deflection and steerability. This report describes the successful deployment of a ventricular LLPM in a patient with prior surgical correction of AV septal defect with subsequent significant right atrial enlargement. The LLPM could not traverse the tricuspid valve. A snare was advanced to the right atrium and used to create greater tip deflection of the delivery sheath. Importantly, once the delivery sheath crosses the tricuspid valve, the snare is loosened to allow directing the sheath to the right ventricular septum rather than the initial direction that was toward the right ventricular apex. The ventricular LLPM was successfully fixated. CONCLUSION: In the presence of complex anatomy, deployment of a LLPM delivery sheath can be facilitated with use of a snare to assist with increased deflection then subsequent guidance to the preferred right ventricular location of the septum.