Dual-chamber leadless pacemaker implant via the RIJ after failed femoral vein implant in a 65-year-old patient with symptomatic bradycardia, with left IJ port and right-sided AV fistula.

Abstract

Introduction: Sinus node dysfunction (SND) is a disorder defined by abnormal initiation and conduction of electrical signals from the sinoatrial node. The preferred first-line treatment for a patient with symptomatic SND is a permanent pacemaker implant. We describe the implantation of an Aveir dual-chamber leadless pacemaker through the right internal jugular vein in a 65-year-old female patient with inaccessible femoral veins and a chemotherapy port in the left internal jugular vein.

Methods: A retrospective review was performed at the University of California at Davis of the dual-chamber leadless pacemaker (Aveir DR) procedure.

Results: A 65-year-old female with a history of chronic dialysis use and chemotherapy, with persistence of left internal jugular vein port, presented with symptomatic bradycardia. After a failed attempt at an outside institution, she presented for a dual-chamber leadless pacemaker implant at our institution. Via the right internal jugular vein, the Aveir VR was deployed with stable thresholds, impedance, and sensing into the ventricular septum, with a subsequent atrial device being deployed with stable thresholds, impedance, and sensing into the right atrial appendage. Follow-up at 8 days demonstrated a ventricular threshold of 0.75V at 0.2 ms, impedance of 440 Ohms, and sensing of 9.9 mV. Follow-up atrial threshold of 0.75V at 0.2 ms, impedance of 400 Ohms, and P wave sensing of 0.8 mV.

Conclusion: Placement of the Aveir dual chamber leadless pacemaker is safe in an adult patient without any complications.