Protruding interventricular septum impacts on leadless pacemaker implantation success: Conversion from helix-fixed to tine-fixed system: A case report

Figures

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  Figure 1. Preimplantation examination before leadless pacemaker implantation. A: The axial image of the cardiac computed tomography (CCT) image. The individual angle in the left anterior oblique view is 57°. B: CCT volume-rendered (VR) images. Left panel: right anterior oblique (RAO) view (31°). Right panel: LAO view (63°). IVC = inferior vena cava; IVS = interventricular septum; LAO = left anterior oblique; RA = right atrium; RV = right ventricle; SVC = superior vena cava; TV = tricuspid valve.

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  Figure 2. Implantation of a helix-fixed leadless pacemaker. A: The right atrioventriculography. Left panel: RAO view, Right panel: LAO view. White triangle shows the IVS. B: Fluoroscopic imaging of the catheter tip in contact toward the IVS on the first attempt. Left panel: RAO view; Right panel: LAO view. C: Fracture of the screw during repeated pretest. D: The damaged helix-fixed pacemaker with a fully extended screw. LAO= left anterior oblique; RAO = right anterior oblique.

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  Figure 3. Successful implantation of a tine-fixed leadless pacemaker. A: Position of tine-fixed leadless pacemaker (LPM) at successful implantation site. Upper panels: fluoroscopy at the success site; lower panels: merged images with cardiac computed tomography volume-rendered (CCT-VR) images. B: Curvature of the delivery catheter of helix-fixed LPM. C: Curvature of the delivery catheter of tine-fixed LPM. The black arrowhead indicates the slight curve facilitating its orientation toward the interventricular septum.

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  Supplementary Figure 1.

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  Supplementary Figure 2.