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Fluoroscopic images from implantation of an AV-Micra (Medtronic Inc, Minneapolis, MN) device implanted via transcarotid access. A: Guidewire is advanced via the carotid artery (arrow). B: A 26F Gore dry sheath is advanced to the heart with the AV-Micra device in transit (arrows). C: AV-Micra device during deployment. D: AV-Micra device following deployment. A pull-back test is performed to ensure stability.
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Following this, an AV-Micra (Medtronic Inc, Minneapolis, MN) leadless pacemaker was deployed into the systemic RV under fluoroscopic guidance without complication (Figure 1).
A: Preprocedural paced electrocardiogram (ECG). B: Postprocedural paced ECG with much-improved QRS width. C: Postoperative chest radiograph. The arrow shows the AV-Micra (Medtronic Inc, Minneapolis, MN) device; also shown is the right-sided epicardial pacemaker and left-sided discarded epicardial pacing leads.
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The paced QRS duration was 90 ms, in comparison to previous epicardial paced QRS of 160 ms (Figure 2A and 2B).