case_images: PMC9851417_01
case_images: Electrocardiogram rhythm strip exhibiting a complete heart block.
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case_images: The patient's electrocardiogram rhythm strip demonstrated the presence of a complete heart block (Figure 1).
case_images: Chest X-ray following external pacemaker implantation demonstrating the presence of five right-sided leads (two leads from the left-sided device, two leads from the right-sided device, and one lead from the external pacemaker).
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case_images: An urgent temporary externalized VVIR pacemaker implant was performed, and the femoral temporary wire was removed (Figure 2).
case_images: Fluoroscopic view demonstrating the final position of the leadless pacemaker in the right ventricular septum.
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case_images: Through right femoral venous access (7F sheath inserted and upsized to 16F), the delivery system was advanced, and the Micra atrioventricular leadless device was positioned in the septal position with good initial measurements (Figure 3).
case_images: Electrocardiogram post leadless pacemaker insertion demonstrating atrioventricular sequential pacing, as the leadless pacemaker was able to track the atrial-paced rhythm from a pre-existing device.
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case_images: Figure 4). Frequencies of AM-VP (atrial mechanical event-ventricular pacing reflecting atrioventricular synchrony during ventricular pacing) and VP (ventricular pacing) were 93.3% and 6.5%, respectively.
case_images: (A) Pacing system analysis demonstrating atrial mechanical sensing and atrioventricular synchronous pacing. (B) Micra atrioventricular leadless pacemaker histogram.
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case_images: At 6 weeks of follow-up, the pacing check revealed a presenting rhythm of AP (from the transvenous pacemaker) and VP (from the Micra device) with appropriate atrioventricular tracking (Figure 5A). The frequencies of AM-VP and VP were 86.9% and 12.8%, respectively (Figure 5B).