Dual Chamber Aveir Retrievable Leadless Pacemaker Implant in a Patient with a Senning Baffle and Subcutaneous ICD

Patients with dextro-transposition (D-TGA) of the great arteries and Senning or Mustard baffles have risk of sinus node dysfunction as well as ventricular arrhythmias. We demonstrate the implantation of a dual-chamber leadless pacemaker in a patient with a Senning baffle and symptomatic bradycardia, in the setting of a primary prevention subcutaneous internal cardioverter defibrillator (SQICD). A retrospective review of a case of dual chamber leadless pacemaker (Aveir DR) implant was performed including atrial baffle and left ventricular septal implant. A 41-year-old female with history of D-TGA and prior defibrillator, post-lead extraction and SQICD placement, after lead malfunction, presented with symptomatic bradycardia. She underwent a dual-chamber leadless pacemaker implant under echocardiographic guidance without complication. At 6-month follow-up, the atrial and ventricular thresholds were 0.5 V@0.2ms and 0.75 V@0.2ms, with impedances of 350 ohms, and 730 ohms, respectively, with an R-wave of 17.3milliVolts. With 99% atrial pacing, and 15% ventricular pacing, the predicted longevity was 13.0 and 18.3 years for atrial and ventricular devices, respectively. No oversensing was noted on the subcutaneous ICD. The patient noted improved activity tolerance and no further presyncope. Successful implantation of a dual-chamber leadless pacemaker can be achieved in the LV septum of a patient with a Senning baffle and previously installed SICD.