{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:05:15Z","timestamp":1784613915985,"version":"3.55.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Leadless pacemakers offer an important alternative for patients with recurrent cardiac implantable electronic device infections. However, clinical data on long-term management and sequential implantation strategies after battery depletion remain limited. We aimed to evaluate the feasibility and safety of a sequential leadless-only pacing strategy in a patient with a multi-decade history of pacing-related complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      We report the long-term clinical course of a patient with a 26-year history of cardiac pacing (2000\u20132026). Following multiple transvenous system failures and recurrent infections, the patient transitioned to a leadless platform in 2017. We describe the clinical rationale and procedural outcome of upgrading from a depleted first-generation leadless pacemaker (Micra VR, implanted 2017, left\n                      <jats:italic>in situ<\/jats:italic>\n                      at the right ventricular septum) to an AV-synchronous leadless pacemaker (Micra AV, implanted 2025 because of battery depletion of the prior device, not infection) using a leave-in-situ approach.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sequential implantation was successfully performed in 2025, with the new device implanted at the right ventricular mid-septum while the previously implanted device was left\n                      <jats:italic>in situ<\/jats:italic>\n                      . Acute electrical parameters were satisfactory (pacing threshold 0.63\u2005V, R-wave amplitude 9.8\u2005mV, impedance 720\n                      <jats:italic>\u03a9<\/jats:italic>\n                      ), with no evidence of inappropriate sensing. At follow-up, electrical parameters remained stable (pacing threshold 0.50\u2005V, impedance 670\u2013650\n                      <jats:italic>\u03a9<\/jats:italic>\n                      ), with atrioventricular synchrony of 80% at 1 month and 84\u201385% at 3\u20136 months. No clinical or device-telemetry evidence of mechanical interaction or electrical interference between the devices was observed during follow-up. No device-related complications occurred during follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A sequential leadless-only pacing strategy, including a leave-in-situ approach, may represent a feasible and safe long-term option in selected high-risk patients with device-related infections and a history of transvenous system extraction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1856082","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:36:04Z","timestamp":1784612164000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Sequential leadless pacing after battery depletion in a patient with recurrent device-related infection"],"prefix":"10.3389","volume":"13","author":[{"given":"Assel","family":"Chinybayeva","sequence":"first","affiliation":[{"name":"Heart Rhythm Scientific Research Institute, NpJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaziza","family":"Marat","sequence":"additional","affiliation":[{"name":"Heart Rhythm Scientific Research Institute, NpJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanasyl","family":"Suleymen","sequence":"additional","affiliation":[{"name":"Heart Rhythm Scientific Research Institute, NpJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]},{"name":"Heart Rhythm Center, National Coordination Center for Emergency Medicine, Ministry of Healthcare of the Republic of Kazakhstan","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayan","family":"Abdrakhmanov","sequence":"additional","affiliation":[{"name":"Heart Rhythm Scientific Research Institute, NpJSC \u201cAstana Medical University\u201d","place":["Astana, Kazakhstan"]},{"name":"Heart Rhythm Center, National Coordination Center for Emergency Medicine, Ministry of Healthcare of the Republic of Kazakhstan","place":["Astana, Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.pcad.2021.06.003","article-title":"Leadless pacemakers: a review of current data and future directions","volume":"66","author":"Middour","year":"2021","journal-title":"Prog Cardiovasc Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"43","DOI":"10.2174\/1573403X19666230331094647","article-title":"Leadless pacemakers: state of the 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pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry","volume":"45","author":"El-Chami","year":"2024","journal-title":"Eur Heart J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"101645","DOI":"10.1016\/j.jaccas.2022.09.015","article-title":"Late-Onset infection in a leadless pacemaker","volume":"4","author":"Bernardes-Souza","year":"2022","journal-title":"JACC Case Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e259564","DOI":"10.1136\/bcr-2023-259564","article-title":"Leadless pacemaker infection: usefulness of positron emission tomography\/computed tomography","volume":"17","author":"Fukuoka","year":"2024","journal-title":"BMJ Case Rep"},{"key":"B13","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.hrcr.2025.11.019","article-title":"Late-onset infection of helix-fixation leadless pacemaker diagnosed by pacing threshold elevation and successfully managed with retrieval and 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Electrophysiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1080\/17434440.2023.2223968","article-title":"Endocardial versus epicardial pacing in pacemaker-dependent patients after device extraction: a meta-analysis","volume":"20","author":"Parlavecchio","year":"2023","journal-title":"Expert Rev Med Devices"}],"container-title":["Frontiers in Cardiovascular 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