Novel Use of Three-Dimensional Transthoracic Echocardiography to Guide Implantation of a Leadless Pacemaker System

Leadless cardiac pacing systems were developed to address the limitations of traditional transvenous pacing devices, particularly pocket- and lead-related complications.1,2 Results from the Micra Transcatheter Pacing Study and the Micra Post Approval Registry have demonstrated high implantation success rates and low risk of major adverse events, with a >60% reduction in complications compared to transvenous pacemakers.2–4 For leadless devices, appropriate positioning within the right ventricle (RV) is critical to optimize pacing capabilities and avoid mechanical complications, including cardiac perforation and interactions with the tricuspid valve (TV) and subvalvular apparatus.