Key result
Micra AV leadless pacemaker implantation with multimodal imaging guidance was successfully achieved with stable pacing parameters and marked symptomatic improvement in a patient with complex congenital heart disease.
Why the study?
Permanent pacing in adults with complex congenital heart disease is challenging due to distorted anatomy, surgically altered venous pathways, and prosthetic valves, particularly in Ebstein's anomaly with cavopulmonary palliation.
Case Report (n=1)
Demonstrates the feasibility and safety of AV synchronous leadless pacing using multimodality imaging guidance in patients with highly complex congenital heart disease and surgically altered venous pathways.
May offer pacing alternative in select complex CHD cases; single-case data leaves broader adoption open.
BACKGROUND: Leadless pacing offers an important alternative to transvenous systems in patients with complex congenital heart disease and limited venous access. CASE SUMMARY: We report the case of a 29-year-old woman with Ebstein anomaly, hypoplastic right ventricle, prior bidirectional Glenn shunt, multiple septal defect repairs, and transcatheter pulmonic valve replacement who presented with symptomatic paroxysmal atrioventricular block. Given preserved biventricular function and complex right-sided anatomy, a leadless pacing strategy was selected. Using transesophageal echocardiography, 3-dimensional electroanatomic mapping, and fluoroscopy guidance, a Micra AV leadless pacemaker was successfully implanted in the anteroseptal aspect of the right ventricle without interfering with the apically displaced septal tricuspid leaflet. DISCUSSION: This case highlights the importance of individualized procedural planning and multimodality imaging to enable safe leadless pacemaker implantation in patients with complex congenital heart disease. TAKE-HOME MESSAGE: Leadless AV synchronous pacing is feasible in complex congenital heart disease with careful procedural planning and imaging guidance.
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Qin et al. (2026) conducted a case report in Complex congenital heart disease with paroxysmal atrioventricular block (n=1). Micra AV leadless pacemaker implantation guided by transesophageal echocardiography and 3D electroanatomic mapping was evaluated on Procedural success and device stability. Micra AV leadless pacemaker implantation with multimodal imaging guidance was successfully achieved with stable pacing parameters and marked symptomatic improvement in a patient with complex congenital heart disease.
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