# High Output Heart Failure Following Leadless Pacemaker Implantation

## TL;DR

A patient developed high output heart failure after a leadless pacemaker implantation due to a rare vascular complication.

## Contribution

Highlights the increased risk of vascular complications with leadless pacemakers compared to traditional devices.

## Key findings

- Leadless pacemakers are associated with a higher risk of vascular complications like pseudoaneurysms and arteriovenous fistulas.
- Arteriovenous fistulas from leadless pacemaker implantation can lead to high output heart failure.
- Surgical repair resolved heart failure caused by the fistula in the reported case.

## Abstract

Leadless pacemakers have a significantly higher risk of vascular complications than traditional transvenous devices.

An 85-year-old man with permanent atrial fibrillation presented with symptomatic bradycardia. A leadless pacemaker was implanted, and the procedure was complicated by a right common femoral vein pseudoaneurysm which was treated with thrombin injection. Months later, he presented with worsening volume overload related to high output heart failure from an arteriovenous fistula at the access site. After surgical repair of his fistula, the patient had resolution of heart failure.

Arteriovenous fistula is a relatively rare complication of cardiac catheterization, but its risk is increased with procedures like leadless pacemaker insertion. Such procedures require a larger caliber sheath, which is associated with a significantly higher risk of vascular complications.

Leadless pacemakers have a unique set of associated vascular complications that could lead to significant adverse outcomes.