Successful implantation of a leadless pacemaker in a patient after tricuspid valve replacement following cardiac tumor removal: a case report and literature review.

INTRODUCTION: Intravenous-cardiac leiomyomatosis (ICL) is a rare condition involving the presence of leiomyomatous tumors within the cardiac venous system. When repairing the tricuspid valve (TV) is not feasible, tricuspid valve replacement (TVR) becomes necessary. However, TVR can lead to complications, including atrioventricular block (AVB), due to potential damage to the cardiac conduction system during surgery. This case report presents the successful implantation of a leadless pacemaker (LP) in a patient who developed advanced AVB after undergoing cardiac tumor removal and bioprosthetic TVR.

CASE PRESENTATION: A 49-year-old female with a history of hysteromyoma and myomectomy presented with sudden syncope. Initial ECG revealed first-degree AVB. Coronary computed tomography angiography (CCTA) and echocardiogram confirmed extensive leiomyomatous involvement in the venous system and heart, diagnosing her with ICL. She underwent total uterine and adnexal resection, tumor debulking, and bioprosthetic TVR. Postoperative assessments were initially normal, showing only first-degree AVB. Eleven months after surgery, the patient developed third-degree AVB, necessitating LP implantation due to poor prognosis and the risks associated with traditional pacemakers. The LP was successfully implanted with optimal parameters (pacing voltage threshold: 0.5 V, R-wave sensing value: 7.3 mV, impedance: 870 Ω). Postoperative follow-up showed stable device function and normal heart parameters.

CONCLUSION: This case describes LP implantation in a patient following cardiac tumor removal and bioprosthetic TVR. The procedure was successful, and short-term follow-up indicated the safety and effectiveness of LP in treating advanced AVB after bioprosthetic TVR. These findings highlight the potential of LP as a treatment option for similar cases in the future.