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Leadless Pacemaker — EECC MCQ

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ModerateCardiac DevicesLeadless PacemakerEECC

A 85-year-old man with symptomatic complete heart block, limited life expectancy due to metastatic cancer, and femoral vein thrombosis bilaterally requires permanent pacing. Subclavian venous access is available but the patient and family wish to avoid a surgical pocket. What pacing system should be considered?

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Correct answer: D — Leadless transcatheter pacemaker (e.g. Micra) implanted via the femoral vein

A leadless transcatheter pacemaker (Micra VR or Micra AV) is implanted directly into the RV via the femoral vein, eliminating the need for a subcutaneous pocket and transvenous leads. Despite bilateral femoral vein thrombosis being mentioned, the Micra can potentially be delivered via internal jugular venous access or after femoral vein recanalisation. Leadless pacemakers are particularly suitable for patients with: high infection risk, limited venous access, limited life expectancy (avoiding lead extraction issues), or patient preference against a visible pocket. The S-ICD provides defibrillation only, not pacing for bradycardia.

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