Wire-free pacemaker, more safety and effectiveness in bacterial endocarditis A case report.

Abstract

Introduction: The number of patients receiving pacemakers annually is increasing due to improved overall survival rates. The frequency of device replacements significantly increases the risk of pacemaker system infections. The optimal approach for patients with device infections, whether at the generator pocket or the electrode level, is complete system explantation accompanied by intravenous antibiotic therapy. The challenge is even more significant in patients dependent on pacing, necessitating device extraction and implantation of a temporary pacing system with its associated potential complications. The development of leadless pacemakers represents a paradigm shift in managing patients requiring permanent pacing. The absence of leads and the elimination of the generator pocket make device infections exceptionally rare.

Case Report: A 73-year-old man with a history of bioprosthetic aortic valve replacement 8 years ago, implantation of a dual-chamber pacemaker due to AV node dysfunction 8 years ago, pacemaker generator replacement in October 2023, and pacemaker generator replacement due to exposure in March 2024 presented. Cultures from the device grew Klebsiella pneumoniae and Morganella morganii. Transthoracic echocardiography demonstrated vegetation on intracavitary leads. A leadless Micra pacemaker was implanted with an apical right ventricular lead.

Conclusions: Implanting a leadless pacemaker in patients with a history of pacemaker infection, especially those with recurrent infections, may be a viable strategy with promising clinical outcomes. The future availability of dual-chamber leadless pacemakers could provide additional benefits by avoiding the limitations of implanting a single-chamber pacemaker in patients who previously had a dual-chamber device.