First Confirmed Case of Leadless Pacemaker Insertion via Bidirectional Glenn Shunt in Ebstein's Anomaly: A Novel Approach to Pacing Challenges.

BACKGROUND

Ebstein's anomaly presents unique pacing challenges due to complex anatomy and surgical history, often leading to transvenous lead complications.

CASE PRESENTATION: A 28-year-old male with Ebstein's anomaly, prior Danielson tricuspid valve repair, and bidirectional Glenn shunt presented with acute ventricular pacing loss from dislodgment of a 4 French SelectSecure Medtronic 3830 lead into the left upper lobe pulmonary artery. An urgent procedure involved inserting an Abbott AVEIR VR leadless pacemaker via the Glenn shunt to the right ventricular apex, achieving stable thresholds (pacing threshold 0.5 V at 0.4 ms, R-wave 8 mV). Multimodal imaging (radiographs, fluoroscopy, angiography, echocardiography) confirmed device position and preserved right ventricular function.

CONCLUSIONS

This first confirmed case demonstrates the feasibility and safety of leadless pacemaker insertion via Glenn shunt in complex congenital heart disease, providing a durable alternative to transvenous systems prone to dislodgment.