Key result
Percutaneous extraction and ICE-guided aspiration successfully resolve MRSA endocarditis on a leadless atrial pacemaker.
Why the study?
Real-world data on device-related infections in newer models like the leadless atrial pacemaker (AVEIR AR) remain limited.
Case Report (n=1)
This first documented case of AVEIR leadless atrial pacemaker endocarditis demonstrates that leadless systems are not immune to serious infections, and highlights ICE-guided percutaneous aspiration as a feasible, minimally invasive management option.
Endocarditis can complicate leadless atrial pacemakers; extends infection reports to atrial devices but leaves management generalizability open.
BACKGROUND: Leadless pacemakers were developed to reduce infection risk compared with transvenous systems. However, real-world data on device-related infections in newer models like the leadless atrial pacemaker (AVEIR AR) remain limited. CASE SUMMARY: A 70-year-old man with atrial fibrillation and prior methicillin-resistant Staphylococcus aureus (MRSA) pacemaker infection presented with acute respiratory failure and MRSA bacteremia 3 months after implantation of the leadless atrial pacemaker. Imaging showed a cystic mass attached to the device. The pacemaker was percutaneously extracted under intracardiac echocardiography guidance. Persistent bacteremia prompted aspiration of the residual mass using a percutaneous aspiration device (AlphaVac system). Cultures confirmed MRSA. DISCUSSION: This represents the first documented case of endocarditis involving a leadless atrial pacemaker system. Although leadless pacemakers are designed to minimize infection, they are not immune to serious complications. TAKE-HOME MESSAGES: Leadless pacemakers can still develop infections. Percutaneous aspiration-guided removal is a feasible management option. Prompt recognition and intervention are essential.
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Karki et al. (2025) conducted a case report in Leadless atrial pacemaker infection (MRSA endocarditis) (n=1). Percutaneous extraction and ICE-guided aspiration was evaluated. Percutaneous extraction and ICE-guided aspiration successfully managed the first documented case of MRSA endocarditis involving a leadless atrial pacemaker in a 70-year-old man.
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