Dual-chamber pacing using a hybrid transvenous and leadless pacing approach

An elderly gentleman with a dual-chamber pacemaker presented to our institution with symptoms of symptomatic bradycardia and high-grade atrioventricular (AV) block. Device interrogation revealed failure to capture in the right ventricle (RV) lead with bipolar pacing, high RV pacing threshold with unipolar pacing, and high impedance suggesting lead fracture. The atrial lead function was normal. Given his advanced age, gait instability, and dementia, the decision was made to proceed with Micra AV pacemaker implantation, while programming his dual-chamber pacemaker to AAIR mode, thus maintaining AV synchrony by tracking paced atrial impulses and providing ventricular pacing.

Automated summary

An elderly patient with dual-chamber pacemaker presented with symptomatic bradycardia and high-grade AV block. Due to lead malfunction and his age-related conditions, a Micra AV pacemaker was implanted while programming the existing pacemaker to AAIR mode for maintaining AV synchrony.