skip to main content

Leadless Pacemaker Indications — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiac DevicesLeadless Pacemaker IndicationsEECC

A 75-year-old man with severe symptomatic bradycardia (sinus pauses >6 seconds with syncope) requires a permanent pacemaker. He has limited vascular access due to bilateral subclavian vein occlusions. What pacing option exists?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Leadless pacemaker (e.g. Micra) — implanted directly into the RV via femoral venous access, eliminating the need for subclavian/axillary venous access, leads, and a subcutaneous pocket

Leadless pacemakers (Micra TPS/AV) are self-contained devices implanted percutaneously via the femoral vein directly into the RV endocardium. They eliminate: (1) subclavian/axillary venous access (useful when occluded or absent); (2) transvenous leads (eliminating lead-related complications: fracture, insulation failure, infection, tricuspid valve impingement); (3) subcutaneous generator pocket (eliminating pocket infection, haematoma, erosion). The ESC 2021 Pacing Guidelines include leadless pacemakers as an option (Class IIa) particularly for: patients with limited vascular access, high infection risk, prior CIED infection, or anticipated need to avoid subclavian vein leads. Current limitations: single-chamber (VVIR or VDD-like) only; no CRT capability; MRI-conditional. The Micra AV model provides AV synchronous pacing by sensing atrial mechanical activity.

Reference: ESC (2021): Guidelines on Cardiac Pacing and CRT