Introduction
Postoperative atrioventricular block (AVB) has been reported in 1% to
6% of patients after cardiac surgery and 25% to 60% of these patients
will finally need a permanent pacemaker (PPM).1-4To
avoid tricuspid valve (TV) malfunction, implantation of transvenous
pacing leads is generally not preferred in presence of the tricuspid
bioprosthesis.5
Leadless pacemakers (LLP) have recently become popular in treatment of
heart blocks and bradyarrhythmia due to their proven safety and
efficacy.6,7 LLPs have advantages of avoiding
complications encountered with conventional transvenous pacemakers
including infection, lead malfunction, and tricuspid valve
regurgitation.8,9 Epicardial pacemaker is the standard
recommendation in the setting of prior tricuspid valve surgery. However,
prior cardiac surgeries are usually associated with significant
pericardial adhesion and most surgeons prefer not to implant epicardial
leads in this setting due to impaired electrical properties of
pericardial leads in the setting of pericardial adhesions. Therefore,
LLPs can be a safe choice for patients with TV surgeries and
postoperative AVB. There is a few data about the LLP implantation in
presence of the bioprosthetic TV (BTV).10-12 In this
report, we described a case of Micra-VR implantation across the BTV in a
patient with repaired congenital heart disease.