From leads to leadless: A convoluted journey

Figures

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  Figure 1. Intraoperative radiograph of epicardial lead placement with a generator placed in the hypochondrium.

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  Figure 2. Intraoperative photograph of the indwelling Micra (Medtronic, Minneapolis, MN) leadless pacemaker in the right ventricle, as viewed through the right atriotomy. The leadless pacemaker had not yet been fully encapsulated by fibrous tissue, having only been in place for under 4 months at the time of tricuspid valve surgery.

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  Figure 3. Serial chest radiographs demonstrating some of the active pacemaker systems used in this patient over the years, with the active pacemaker generator(s) highlighted in red. A: Left pectoral transvenous dual-chamber pacemaker. B: Right pectoral transvenous dual-chamber pacemaker. C: Temporary single-chamber ventricular externalized pacemaker via the right internal jugular vein. D: Epicardial single-chamber pacemaker. E: Leadless pacemaker (primary functioning pacemaker) and epicardial single-chamber pacemaker (set for backup pacing). F: Leadless pacemaker after epicardial pacing system was explanted. Note that the original abdominal pacemaker system and the temporary externalized pacing system that was in place between panels A and B are not pictured.