Key result
Video-assisted direct leadless pacemaker implantation during open heart surgery allows direct visualization of the right ventricular septum, avoiding the risk of cardiac perforation.
Why the study?
Fluoroscopic techniques to identify the RV septum during transvenous leadless pacemaker implantation are not definitive, risking devastating cardiac perforation, whereas open heart surgery allows direct visualization.
Case Report
Direct visualization during open heart surgery may offer a safe alternative for leadless pacemaker implantation by avoiding the risk of cardiac perforation associated with fluoroscopic guidance.
Direct visualization during open-heart surgery may enable safe leadless pacemaker placement; hypothesis-generating and requires prospective validation.
Leadless pacemaker implantation is generally performed transvenously from the femoral vein or internal jugular vein.1,2 Fluoroscopy guides the catheter to the right ventricular (RV) septum, minimizing risk of cardiac perforation related to the implantation. While several fluoroscopic techniques are described to identify the RV septum, none are definitive, and cardiac perforation can be a devastating complication because of the large size of the sheath and device.3–5 During open heart surgery the RV septum and trabeculations may be directly visualized, avoiding the risk of cardiac perforation.
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Arunthamakun et al. (2024) conducted a case report in Patients undergoing open heart valve surgery requiring pacemaker implantation. Video-assisted direct leadless pacemaker implantation was evaluated. Video-assisted direct leadless pacemaker implantation during open heart surgery allows direct visualization of the right ventricular septum, avoiding the risk of cardiac perforation.
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