First-in-Human Helical-Fixation Leadless Pacemaker in the Left Atrium for D-Transposition With Atrial Switch Procedure.

Background: The atrial switch procedure is accompanied by a very high rate of sinus node dysfunction. Baffle stenosis is a common problem with transvenous pacemaker leads in this scenario.

Case Summary: We present a first-in-human case of a leadless pacer (LP) in the left atrium in a patient with prior atrial switch for transposition and sinus node dysfunction complicated by multiple abandoned leads, superior baffle occlusion, and failed extraction. We outline difficulties and potential advantages of this approach.

Discussion: There is no published experience implanting a helical-fixation leadless pacemaker in a subpulmonic morphologic left atrium. Because implant options for this population are limited, this case illustrates an alternative to transvenous approaches.