Leadless pacemaker implantation: An unexpected complication

Abstract

The leadless pacemaker is an emerging technology with high efficacy and reduced complications rates. However, due to its novel status, some pitfalls remain to be addressed. We report the case of a 91‐year‐old patient undergoing a Micra pacemaker implantation. During the procedure, the maneuvers required for the adequate deployment of the device led to damaging of the septal tricuspid leaflet, resulting in severe tricuspid regurgitation. This is a severe mechanical complication of the Micra implantation technique, not previously reported in literature. In light of the novelty of the leadless pacemaker, we should remain cautious with regards to potential unreported complications.

Characteristics and Incidence of Patients With Tricuspid Valve Prolapse After Micra Transcatheter Pacing System Implantation

“…Similar cases have been reported at other centers and it is important to recognize that this complication can occur with Micra TPS implantation in vivo. 4,5,6 Mechanisms for TV prolapse as a mechanical complication of Micra TPS implantation may include damage to tricuspid complex due to device manipulation, pushing during deployment, traction during retrieval and trapping between the device cup and body during recapture. Transesophageal echocardiography may be useful for detecting the damage to TV or subvalvular tissue during the Micra TPS implantation.…”

“…3 However, several centers have experienced a few cases of TV prolapse due to chordae tendineae rupture and worsening of TR after Micra TPS implantation. 4,5,6 The clinical characteristics of patient groups with TV prolapse caused by Micra TPS implantation are unknown.…”