case_images: PMC7346111_01
case_images: Transthoracic and transesophageal echocardiograms after leadless pacemaker insertion. (a) A transthoracic echocardiogram (parasternal long) taken after insertion of the leadless pacemaker showing incomplete coaptation of mitral valve leaflets. (b) A transthoracic echocardiogram with color (parasternal long) showing severe mitral regurgitation (effective regurgitant orifice area of 0.51 cm2 and regurgitant volume of 52 ml) after leadless pacemaker insertion. (c) A transesophageal echocardiogram showing incomplete coaptation of mitral valve leaflets following leadless pacemaker implantation. (d) A transesophageal echocardiogram with color showing severe mitral regurgitation following leadless pacemaker implantation.
case_images: CRIC2020-5389279.001.jpg
case_images: PMC7346111_01_CRIC2020-5389279.001.jpg
case_images: fig1
case_images: He underwent a transthoracic echocardiogram which showed normal left ventricular size and no wall motion abnormalities, LVEF of 56%, severe mitral regurgitation due to incomplete coaptation of the mitral valve leaflets (Figures 1(a) and 1(b)), mild right ventricular enlargement, systolic dysfunction with visible apical right ventricular lead, mild tricuspid regurgitation, and no pericardial effusion. A transesophageal echocardiogram confirmed restricted mitral valve leaflets resulting in incomplete coaptation and severe mitral regurgitation (Figures 1(c) and 1(d)).
case_images: ECG prior to leadless pacemaker insertion. An ECG demonstrating atrial fibrillation with a rapid ventricular rate prior to insertion of the leadless pacemaker.
case_images: CRIC2020-5389279.002.jpg
case_images: PMC7346111_01_CRIC2020-5389279.002.jpg
case_images: fig2
case_images: Despite this treatment, he had recurrent episodes of paroxysmal symptomatic atrial fibrillation with a rapid rate requiring multiple emergency department visits and hospital admissions (Figure 2).
case_images: ECG after leadless pacemaker insertion. An ECG taken after insertion of the leadless pacemaker that demonstrates LBBB.
case_images: CRIC2020-5389279.003.jpg
case_images: PMC7346111_01_CRIC2020-5389279.003.jpg
case_images: fig3
case_images: Given difficulty to control the rate, he underwent AV nodal ablation and leadless pacemaker insertion 15 days prior to current presentation with resultant LBBB on his electrocardiogram (ECG) post implantation (Figure 3).
case_images: Echocardiograms 25 days prior to leadless pacemaker insertion. (a) A transthoracic echocardiogram (parasternal long) prior to leadless pacemaker insertion showing normal coaptation of mitral valve leaflets. (b) An apical 4-chamber view taken prior to leadless pacemaker insertion showing only mild mitral regurgitation.
case_images: CRIC2020-5389279.004.jpg
case_images: PMC7346111_01_CRIC2020-5389279.004.jpg
case_images: fig4
case_images: His echocardiogram days before pacemaker insertion revealed only mild mitral regurgitation and normal coaptation of the mitral valve leaflets (Figure 4).