Combined Leadless Pacing and Subcutaneous ICD Therapy in Long QT Syndromes

Congenital long QT syndrome (LQTS) is associated with ventricular arrhythmias and increased risk of sudden cardiac death. Beta-blockers are first-line therapy, although intolerance may occur. We report a case of a 50-year-old man with LQTS and subcutaneous implantable cardioverter-defibrillator (S-ICD) who experienced recurrent appropriate therapies and beta-blocker intolerance due to bradycardia. An atrial leadless pacemaker was implanted while maintaining the S-ICD, achieving a double-device strategy without intracardiac leads. This approach resulted in QTc shortening, symptom improvement, and complete suppression of further ICD therapies. This strategy may represent a feasible and effective alternative in selected LQTS patients requiring atrial pacing.