Key result
Leadless atrial pacemaker embolization into the iliac vein presents as rhythmic lower extremity spasms.
Why the study?
Leadless pacemaker dislodgement and embolization are rare but recognized adverse events with limited reported presentations.
Case Report (n=1)
New-onset rhythmic muscle spasms after leadless pacemaker implantation may be an early sign of device migration into the iliac venous system.
Alerts clinicians to monitor for atypical embolization symptoms post-leadless pacemaker implantation; leaves open optimal management strategies.
BACKGROUND: Leadless pacemakers are associated with high procedural success and low complication rates; however, device dislodgement and embolization remain rare but recognized adverse events. Most reported cases involve embolization to the pulmonary vasculature. CASE SUMMARY: An 80-year-old woman underwent uncomplicated implantation of a leadless atrial pacemaker for symptomatic sinus node dysfunction. Overnight, she developed rhythmic unilateral lower extremity spasms. Telemetry and electrocardiogram demonstrated atrial undersensing and loss of capture. Physical exam revealed involuntary leg and gluteal contractions at 60 beats/mins. Imaging localized the pacemaker to the right internal iliac vein. Device deactivation resulted in immediate symptom resolution, confirming extracardiac pacing-induced skeletal muscle stimulation. DISCUSSION: This represents the first reported case of leadless pacemaker embolization into the iliac venous system presenting with neuromuscular stimulation, expanding the spectrum of leadless pacemaker complications. TAKE-HOME MESSAGE: New-onset rhythmic muscle spasms after leadless pacemaker implantation may be an early sign of device migration and extracardiac pacing.
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Belamkar et al. (2026) conducted a case report in Symptomatic sinus node dysfunction (n=1). Leadless atrial pacemaker implantation was evaluated on Device migration and clinical presentation. Leadless atrial pacemaker embolization into the iliac venous system presented as rhythmic gluteal and lower extremity spasms due to extracardiac pacing.
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