What does this research mean for the field?

Sequential implantation of an AV-synchronous leadless pacemaker while leaving a depleted leadless device in situ is safe and feasible, maintaining stable electrical parameters without mechanical or electrical interference. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 21, 2026Frontiers in Cardiovascular MedicineOpen Access

Case Report: Sequential leadless pacing after battery depletion in a patient with recurrent device-related infection

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Battery depletion of leadless pacemaker with recurrent device-related infection (n=1). Intervention: Sequential leadless pacing (Micra AV implantation with leave-in-situ of Micra VR). Primary outcome: Feasibility, safety, and electrical parameters (pacing threshold, impedance, AV synchrony).

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Key result

Sequential AV-synchronous leadless pacemaker implantation alongside a depleted device maintains ~85% AV synchrony at six months.

Why the study?

Clinical data on long-term management and sequential implantation strategies after battery depletion in patients with leadless pacemakers remain limited.

Does a sequential leadless-only pacing strategy (leave-in-situ approach) provide a safe and feasible option for battery depletion in a patient with recurrent device-related infections?

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does a sequential leadless-only pacing strategy (leave-in-situ approach) provide a safe and feasible option for battery depletion in a patient with recurrent device-related infections?

Population

A 65-year-old pacemaker-dependent patient with a history of recurrent device-related infections and battery depletion of a first-generation leadless pacemaker, followed for 6 months after sequential implantation.

Intervention

Sequential leadless-only pacing strategy: implantation of an AV-synchronous leadless pacemaker (Micra AV) at the right ventricular mid-septum while leaving a depleted first-generation leadless pacemaker (Micra VR) in situ.

Outcome

Feasibility and safety of a sequential leadless-only pacing strategy (acute electrical parameters, atrioventricular synchrony, mechanical interaction, electrical interference, and device-related complications at 6 months).safety

Sequential implantation of a new leadless pacemaker while leaving a depleted device in situ is a feasible and safe strategy for pacemaker-dependent patients at high risk of infection.

Limitations

Spatial separation between devices was confirmed only by fluoroscopy without adjunctive echocardiography or formal quantification.
The exact causative organism for earlier infections was not definitively established.
Follow-up assessment for device-device interaction relied primarily on interrogation of the newly implanted Micra AV.
The chronically implanted Micra VR was left in a low-output backup mode rather than fully deactivated.
Single-patient case report limits generalizability.
Confirmation of spatial separation relied on fluoroscopic visualization in two projections without adjunctive echocardiography or formal quantification of inter-device distance.
Exact causative organism or dominant patient-specific risk factor underlying the earlier transvenous-era infections could not be definitively established.
Follow-up assessment for device-device interaction relied primarily on interrogation of the newly implanted Micra AV; VVI pacing episodes of the backup-mode device were not separately quantified.
Chronically implanted Micra VR was left in a low-output backup (VVI 30) rather than fully deactivated mode.
Single-patient case report, limiting generalizability.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Should not yet change practice in high-risk patients; leaves open sequential leave-in-situ leadless pacing after battery depletion.

Cite This Study

Chinybayeva et al. (2026) conducted a case report in Battery depletion of leadless pacemaker with recurrent device-related infection (n=1). Sequential leadless pacing (Micra AV implantation with leave-in-situ of Micra VR) was evaluated on Feasibility, safety, and electrical parameters (pacing threshold, impedance, AV synchrony). Sequential implantation of an AV-synchronous leadless pacemaker while leaving a depleted device in situ was safe and feasible, maintaining stable electrical parameters and 85% atrioventricular synchrony at 6 months without mechanical interaction or infection.

synapsesocial.com/papers/6a7faa38a3d55be9ef9fe84b https://doi.org/10.3389/fcvm.2026.1856082

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Case Report: Sequential leadless pacing after battery depletion in a patient with recurrent device-related infection

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Case Report: Sequential leadless pacing after battery depletion in a patient with recurrent device-related infection

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

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