Yagasaki Hiroto, Suzuki Takeki, Warita Shunichiro, Noda Toshiyuki
Department of Cardiology, Gifu Prefectural General Medical Center, Gifu City, Japan.
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
JACC Case Rep. 2024 Nov 20;29(22):102660. doi: 10.1016/j.jaccas.2024.102660.
Leadless pacemakers (LPMs) offer an alternative for patients with challenging venous access or device infection history. Management of LPM battery depletion in frail patients presents unique challenges. We present the case of an 81-year-old frail woman with obstructive hypertrophic cardiomyopathy and complete heart block, previously treated with percutaneous transseptal myocardial ablation and a transvenous pacemaker, who received an LPM after device extraction for infection. On battery depletion, a second LPM was implanted but dislodged, thus necessitating extraction attempts. Given the high extraction risks, a third LPM was successfully implanted. This case highlights the feasibility of multiple LPM implantations in complex cardiac patients and demonstrates that a third LPM can be a viable option when extraction risks are high. This approach expands management options for frail patients with complex cardiac histories who are unsuitable candidates for traditional pacing systems.
无导线起搏器（LPMs）为静脉通路建立困难或有设备感染史的患者提供了一种替代方案。在体弱患者中管理LPM电池耗尽存在独特的挑战。我们报告一例81岁体弱女性患者，患有梗阻性肥厚型心肌病和完全性心脏传导阻滞，此前接受过经皮经间隔心肌消融术和经静脉起搏器治疗，因感染在取出设备后植入了LPM。在电池耗尽时，植入了第二个LPM，但发生移位，因此需要尝试取出。鉴于取出风险高，成功植入了第三个LPM。该病例突出了在复杂心脏疾病患者中多次植入LPM的可行性，并表明当取出风险高时，第三个LPM可能是一个可行的选择。这种方法扩展了对于有复杂心脏病史、不适合传统起搏系统的体弱患者的管理选择。
