Po-05-143 implanting an active helix-fixation leadless pacemaker in a patient with existing heartware left ventricular assist device

Leadless pacemakers (LP) are being increasingly utilized to avoid complications associated with transvenous pacemakers, such as infection, venous occlusion, tricuspid regurgitation, and lead related complications (dislodgment, fracture, or insulation failure). The new AVEIR LP (Abbott Medical, Sylmar, CA) is the second leadless pacing system to become available in the US in 2022 after the MICRA device. There is limited data regarding the safety and efficacy of LPs in patients with left ventricular assist devices (LVADs), electromagnetic interference (EMI) from LVADs is a concern, and little is known about the interaction of LVAD with novel conductive communication unique to AVEIR LP. We describe a case of successful implantation of an AVEIR LP in a patient with HeartWare LVAD. N/A A 66-year-old woman with a HeartWare (Medtronic) LVAD was referred for a permanent pacemaker implantation due to episodes of bradycardia dependent torsades. Given low pacing requirement with no need of defibrillator therapy, implantation of a AVEIR LP was planned to decrease risks associated with transvenous pacemakers. Prior to the procedure, noise, threshold, and saturation scores were evaluated for potential communication issues with the LP. Traditional antero-lateral patch placement revealed unacceptable results, and the two left sided patches were modified to a postero-lateral location circumferentially around the patient, and further from the LVAD, which resulted in acceptable values and confidence in device to programmer communication during the implant. The LP was implanted using standard techniques. After crossing the tricuspid valve, contrast injections revealed optimal low septal placement, and electrical mapping was used to identify an optimal location before fixating the helix. During the immediate postoperative period and at two-week follow up, the device showed no EMI and no difficulties communicating with the programmer. This is the first description of implantation of an AVEIR LP in a patient with HeartWare LVAD. LP implantation with perioperative mapping capability and helix-driven fixation method is feasible and may be an effective alternative to transvenous pacemakers in patients with LVAD. In the presence of an LVAD, optimizing conductive communication with the LP may require adjustment of patch placement to a nontraditional location. Further studies are needed to evaluate the safety and efficacy of leadless pacemaker devices in this unique cohort of patients.