# Successful Leadless Pacemaker Implantation After Lead Extraction in a Patient With Ventricular Septal Defect Patch

## TL;DR

A 76-year-old man with a repaired heart defect successfully had a new pacemaker implanted after removing an infected one.

## Contribution

Demonstrates successful leadless pacemaker implantation after lead extraction in a complex congenital heart disease case.

## Key findings

- Combined laser and mechanical sheath techniques enabled complete lead removal despite dense adhesions.
- Pre-fixation mapping allowed safe leadless pacemaker implantation avoiding the calcified VSD patch.
- The strategy proved feasible for complex congenital heart disease anatomy.

## Abstract

Lead extraction and reimplantation in adult congenital heart disease (CHD) patients is challenging due to anatomical complexity.

A 76‐year‐old man with prior ventricular septal defect (VSD) patch repair and pacemaker implantation developed a device infection. Complete transvenous lead extraction (TLE) was achieved using laser and mechanical sheaths. A leadless pacemaker (Aveir VR) was implanted at the right ventricular outflow tract (RVOT) using pre‐fixation mapping to avoid the VSD patch.

This case illustrates the effectiveness of pre‐mapping in achieving safe reimplantation of a leadless pacemaker after TLE in complex CHD anatomy.

This report describes successful transvenous lead extraction followed by leadless pacemaker (Aveir VR) implantation in a 76‐year‐old man with a repaired VSD and chronic device infection. Dense intravascular adhesions required combined laser and mechanical sheath techniques for complete lead removal. Pre‐fixation mapping enabled safe deployment of the leadless pacemaker while avoiding the calcified VSD patch, demonstrating the feasibility of this strategy in complex congenital heart disease cases.