Key result
Partial catheter rotation enables successful Aveir AR implantation in a markedly small right atrial appendage.
Why the study?
Although the efficacy and safety of leadless pacemakers are reported, implantation can be challenging in patients with anatomical variations.
Case Report (n=1)
Limited outer-helix rotation while maintaining catheter deflection can facilitate atrial leadless pacemaker fixation in patients with extreme right atrial appendage hypoplasia as a bailout strategy.
May enable Aveir AR fixation in hypoplastic RAA as bailout; hypothesis-generating and requires prospective validation before broader adoption.
Background An atrial leadless pacemaker (Aveir AR [Abbott]) has recently become available, enabling atrial pacing and maintaining strict atrioventricular synchronization. Although the efficacy and safety of leadless pacemakers have already been reported, some cases present challenges during implantation due to anatomical variations. Case Summary A 66-year-old man visited our hospital complaining of dizziness. A 12-lead electrocardiogram exhibited junctional rhythm with a heart rate of 40 beats/min. A leadless pacemaker was implanted instead of a transvenous pacemaker because of daily oral steroid administration and the risk of a pocket infection. The Aveir AR delivery catheter was guided to the base of the right atrial appendage (RAA) using deflection maneuvers. However, upon deflection release, the catheter tip slipped toward the superior vena cava because of the significantly small RAA. To avoid catheter tip slip, the catheter lever was turned clockwise to rotate the chevron marker one-quarter from its initial position while maintaining deflection. Mapping measurements obtained while maintaining catheter deflection were favorable. Even after releasing the deflection, the catheter tip position remained stable at the RAA base without slippage. Subsequently, the delivery catheter deflection was released, and the chevron marker 1 1/2 was rotated under fluoroscopy. The Aveir AR position and each final parameter were favorable. No adverse events, including cardiac tamponade and dislodgement, were recorded. Discussion This case highlights the specific bailout technique using partial rotation while maintaining deflection for Aveir AR implantation in a markedly small RAA; however, it should not replace standard implantation technique.
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Watanabe et al. (2026) conducted a case report in Sick sinus syndrome (n=1). Aveir AR leadless pacemaker implantation using a bailout technique (partial rotation while maintaining deflection) was evaluated on Successful implantation and stable pacing parameters. A bailout technique involving partial rotation while maintaining catheter deflection enabled successful implantation of an Aveir AR leadless pacemaker in a markedly small right atrial appendage.
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