LAUSR

Introduction Permanent cardiac pacing has afforded immense benefit and treatment to millions of patients who have suffered from bradyarrhythmias. Since its inception, cardiac implantable electronic devices (CIED) were limited to subcutaneously implanted generatorswith 1 ormore transvenous leads.Owing to the numerous potential complications inherent to a transvenous device implantation, such as pneumothorax, hemothorax, pocket hematoma, infection, and lead dislodgement, a solution was put forth in 2016 with the introduction of the leadless ventricular pacemaker, known as the Micra (Medtronic, Inc, Minneapolis, MN). While this device showed a 48% reduction in complication rate vs transvenous devices, its 1 drawback was the lack of atrioventricular (AV) synchrony. Fortunately, this issue was resolved with the improvement and implementation of an accelerometer-based algorithm, allowing for atrial mechanical, as opposed to electrical, sensingwith appropriate ventricular pacing, with the release of the Micra AV in the beginning of this year. As the intended indications for the Micra AV implantation include a patient who has complete heart block with either a high risk of infection, transvenous access issues, or both, there has never been a need to combine a transvenous device with the new leadless pacemaker system. We report the first ever case of a Micra AV synchronized with a transvenous atrial pacemaker.