Optimizing cardiac device management: Leadless pacemaker implantation together with an implantable cardioverter-defibrillator lead in a diaphragmatic stimulation case

Figures

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  Figure 1. A: Electrocardiogram (ECG) at baseline before first implantable cardioverter-defibrillator (ICD) implantation showing sinus rhythm with frequent premature ventricular contractions. B: Strip of an episode of nonsustained ventricular tachycardia. C: Episode on remote monitoring, showing an episode of ventricular tachycardia correctly interrupted by ICD on low dose of bisoprolol. D: ECG at the admission in hospital showing sinus bradycardia and first-degree atrioventricular block and left anterior fascicular block. E: ECG at hospital discharge with an atrial-guided rhythm (pacemaker leadless pacing in VDD mode).

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  Figure 2. Transthoracic echocardiogram. A: Two-chamber view on the right and 4-chamber view on the left. B: Four-chamber view with apical zoom.

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  Figure 3. A: Anteroposterior (AP) and laterolateral (LL) view of chest radiograph of the patient some years before showing the initial position of implantable cardioverter-defibrillator (ICD) transvenous lead. B: Postimplant AP and LL chest radiograph showing leadless pacemaker together with the previous transvenous lead, which was slightly more advanced than before, consistently with a delayed microperforation in a chronic setting; also, ICD generator is different because the patient underwent a generator elective replacement. C: Morphology of spontaneous (circled in blue) and leadless pacemaker–induced (circled in red) rhythm at ICD interrogation.