Tricuspid leaflet flail after Micra (TM) leadless pacemaker implantation: a case report

Background Currently, the leadless pacemaker indications are limited to few and highly selected cases. Case summary We describe the first reported case of an atrioventricular Micra (TM) leadless pacemaker implantation complicated by tricuspid posterior leaflet flail with severe regurgitation in a 29-year-old man affected by asymptomatic and progressive high degree atrio-ventricular block. The patient was then treated with endoscopic tricuspid valve repair, leadless pacemaker removal and implantation of an epicardial pacemaker. Discussion Leadless pacemaker complications are multiple, hence it is essential to ensure a safe procedure, especially in the younger patients. We thought that the application of a transesophageal echocardiography guidance might mitigate the risk of major complications.