Successful implantation of a leadless pacemaker in a patient after tricuspid valve replacement following cardiac tumor removal: a case report and literature review

Abstract Introduction Intravenous-cardiac leiomyomatosis (ICL) is a rare condition characterized by the presence of leiomyomatous tumors within the cardiac venous system. Tricuspid valve replacement (TVR) is often required when the tricuspid valve (TV) is difficult to repair. However, complications such as atrioventricular block (AVB) can arise from damage to the cardiac conduction system during TVR surgery. This case highlights the successful implantation of a leadless pacemaker (LP) in a patient with advanced AVB following cardiac tumor removal combined with bioprosthetic TVR. Case Presentation Our patient, a 49-year-old female with a history of hysteromyoma and myomectomy, presented with sudden syncope and was diagnosed with ICL. Cardiac tumor removal was performed, and due to the inability to repair the TV, TVR with a bioprosthesis was undertaken. Postoperative assessments, including Electrocardiogram (ECG) and transthoracic echocardiography (TTE), revealed no significant abnormalities in electrocardiographic activity or structural changes in the heart. The patient was readmitted in November after surgery with syncope and was diagnosed with third-degree AVB, likely attributed to the TVR surgery. Considering the patient's age, medical history, and quality of life needs, the decision was made to proceed with implantation of a leadless pacemaker (LP), Micra, 11 months after cardiac tumor removal combined with bioprosthetic TVR. Conclusion This case represents the first reported instance of LP implantation in a patient following cardiac tumor removal combined with bioprosthetic TVR. The procedure was successful, and short-term follow-up indicated the safety and effectiveness of LP in treating advanced AVB after bioprosthetic TVR. These findings highlight the potential of LP as a treatment option for similar cases in the future.