Successful implantation of leadless pacemaker in patient with the Günther Tulip inferior vena cava filter.

Leadless pacemakers have many advantages for some patients in preventing lead- and pocket-related complications. The traveling of the femoral vein is important in the context of normal approach site choice for leadless pacemakers. In this case, the leadless pacemaker could be successfully implanted without disrupting the inferior vena cava filter by using intravascular ultrasound in a hemodialysis patient with complete atrioventricular block and atrial fibrillation who had obstruction of the bilateral subclavian and right femoral veins, and travel abnormality of the left common iliac vein. <Learning objective: The leadless pacemaker is a useful option in patients with complex vascular complications and hemodialysis. However, there are several listed contraindications such as the presence of inferior vena cava (IVC) filter that was excluded in the large-scale trials to leadless pacemakers. Intravascular ultrasound is a useful tool to place the leadless pacemaker without disrupting IVC filter to maintain its filtering capability.>.