Leadless pacemaker implantation in challenging scenarios: A case report series of patients with mechanical tricuspid valves

INTRODUCTION: The advancement of medical technology has introduced leadless pacemakers (LPMs) as a significant innovation in cardiac pacing, offering potential advantages over traditional ventricular transvenous pacemakers. This report explores the application of LPMs in two patients with complex valvular histories, particularly those with mechanical tricuspid valves. CASE REPORTS: The first case involves a 60-year-old male with a history of rheumatic heart disease and triple valve replacement who developed a high-grade AV block. Due to significant RV pacing, a single-chamber VVI pacemaker using the Micra Transcatheter Pacing System was successfully implanted, navigating the mechanical tricuspid valve with stable pacing parameters. The second case describes a 70-year-old female with HIV, diabetes, hypothyroidism, and multiple valve surgeries presenting with syncope and dyspnea. Given her complex medical history and recurrent conduction issues, the Micra pacemaker was chosen. Despite initial resistance, successful deployment was achieved at the lower septum with acceptable pacing thresholds. DISCUSSION: LPMs offer a promising alternative for patients with mechanical tricuspid valves, eliminating the risks associated with transvenous leads. The Micra system's minimally invasive approach and stable performance in these challenging cases suggest its potential viability in high-risk patients with complex valvular conditions. CONCLUSION: These cases demonstrate the feasibility of LPM implantation through mechanical tricuspid valves; however, given the associated risks, careful evaluation and meticulous procedural planning are essential before considering this approach.