All the king's men (and women): Fluoro-less leadless pacemaker implant in a severely obese patient.

Introduction: Severe obesity presents significant challenges in imaging and delivery of therapy, including pacemaker implant.

Methods And Result: We present our experience implanting a leadless pacemaker (LP) in a severely obese man presenting with heart block. We describe our multidisciplinary approach using right internal jugular venous access and transesophageal imaging in lieu of fluoroscopy which failed to provide workable images in this instance.

Conclusion: Ultrasound guided LP placement may have wider application in the midst of an ongoing obesity epidemic where fluoroscopy imaging is both limited and unsafe.