Challenges and advances in ventricular leadless pacemaker implantation for patients with single ventricle physiology: A case series

Figure 1. Arrythmia for Case 1. A: Supraventricular tachycardia with aberrancy. B: Baseline normal sinus rhythm with RBBB morphology. C: Post-implantation EKG at rate of 90 with resolution of tachycardia. RBBB QRS morphology remains unchanged from prior (Patient 1). RBBB = right bundle branch block.

Figure 2. TEE guidance for Micra LPPM placement, Case 1. A: TEE Image 1 showing LPPM traversing tricuspid valve. B: TEE image showing LV, systemic RV, VSD, and leadless system in systemic RV. C, D: TEE showing final placement of Micra system. LPPM = leadless pacemaker; LV = left ventricular; RV = right ventricular; TEE = trans-esophageal echocardiography; VSD = ventricular septal defect.

Figure 3. Fluoroscopy views after Micra placement, Case 1. (A) RAO and (B) LAO images showing final position of Micra. C: Chest X-ray showing placement of Micra (denoted by ∗) near RV septum. LAO = left anterior oblique; RAO = right anterior oblique; RV = right ventricular.

Figure 4. Presenting arrythmias in Case 2. A: AF with slow-ventricular response. B, C: Telemetry evidence of long-short sequence and polymorphic VF. AF = atrial fibrillation; VF = ventricular fibrillation.

Figure 5. Intracardiac echocardiography guidance for Aveir LPPM placement, Case 2. (A) Intracardiac echocardiogram image showing initial placement of device was in more anterior position and (B) after repositioning, was placed in a more central and apical position. LPPM = leadless pacemaker.

Figure 6. RAO 30° fluoroscopy views after Aveir LPPM placement, Case 2. Final placement here differs from active fixation lead (Case 1). LPPM = leadless pacemaker; RAO = right anterior oblique.