Synchronous atrio-ventricular sequential pacing utilising conventional and leadless pacemakers in an elderly patient: a case report


 
 
 Leadless pacemakers present a viable alternative to conventional transvenous devices to mitigate the risk of lead and/or pocket related complications. In elderly patients who have encountered ventricular lead failures with transvenous pacemakers, this option may enable the delivery of atrio-ventricular synchronous pacing therapy whilst obviating the requirement for lead extraction and lead-based pacemaker re-implantation.
 
 
 
 This case report describes the successful implantation of a leadless pacemaker in a 90-year-old who had undergone two dual chamber permanent pacemaker implantation procedures with failure of three of four previously implanted leads. Atrio-ventricular synchronous pacing was achieved as the leadless device was able to track the atrial paced rhythm from the pre-existing right-sided device.
 
 
 
 In elderly patients who have encountered issues with transvenous pacemakers, alternate approaches should be considered to mitigate the risk of future complications. Leadless pacemakers may offer a low-risk solution enabling the delivery of atrio-ventricular synchronous pacing therapy in such patient groups. Future studies should be designed to delineate whether these devices could be utilised as a first-line approach in certain situations.
