Tortuous inferior vena cava with severe scoliosis: An impediment to successful leadless pacemaker implantation

Abstract

Both a multicenter cohort and a post-approval registry of the Micra™ transcatheter pacemaker (Medtronic, Minneapolis, MN, USA) reported high successful implantation rates (>99%) with long-term stability of electrical performance and long-term safety. Therefore, there has been little discussion on the causes of cases of failure in terms of anatomical findings. We report a case of failure of implantation of the Micra because of a tortuous inferior vena cava (IVC) secondary to severe scoliosis. A retrospective assessment of 3D reconstructed computed tomography imaging could visualize the configuration of the IVC-right atrium junction. A preprocedural anatomical assessment may help to predict the implantability of the transcatheter leadless pacemaker or to image the manipulation of the delivery catheter. <Learning objective: The Micra™ leadless pacemaker had high successful implantation rates (>99%). There has been little discussion on the causes of cases of failure in terms of anatomical findings. We report a case of failure of implantation of the Micra device because of a tortuous inferior vena cava secondary to severe scoliosis. A preprocedural 3D reconstructed computed tomography may help to predict the procedural difficulty of the Micra implantation or to image a manipulation of the delivery catheter.>.

Keywords: Complication; Leadless pacemaker; Micra.