Atrial leadless pacing for heart failure in sick sinus syndrome

Two patients with sick sinus syndrome and heart failure were treated with atrial leadless pacing. Case 1 demonstrated hemodynamic improvement with cardiac output increase (3.0 → 5.1 L/min), B-type natriuretic peptide (BNP) reduction (3223 → 480 pg/mL), and New York Heart Association class improvement (III → I) following Aveir dual-chamber leadless pacemaker (Abbott Medical, Inc., Plymouth, MN, USA) implantation. Case 2, at high infection risk with mechanical valve and prior endocarditis, received hybrid therapy combining atrial fibrillation ablation, Aveir atrial pacing, and subcutaneous implantable cardioverter-defibrillator implantation, achieving left ventricular ejection fraction improvement (20 → 38%) and BNP reduction (321 → 28 pg/mL). Atrial leadless pacing may represent a therapeutic option in selected patients with preserved atrioventricular conduction or high infection risk requiring physiologic pacing. Learning objective This case report demonstrates that atrial leadless pacing can be an effective treatment option for patients with sick sinus syndrome complicated by heart failure when conventional transvenous atrial pacing is undesirable. In one of the presented cases, the feasibility of combining a leadless pacemaker with a subcutaneous implantable cardioverter-defibrillator is also illustrated, providing insight into a potential lead-free device strategy.