Leadless pacemaker (LPM) is known to be as safe and effective as transvenous pacemaker (TV-PM).1,2 TV-PM has complications with lead-related tricuspid regurgitation (TR), and it was reported that 25%-50% of patients with TV-PM developed TR intensification.3 Additionally, LPM related TR has also been reported despite the absence of lead on LPM.4 Complications of tricuspid valve chordae tendineae were reported in the past,5,6 but it is not well recognized. We experienced a case of severe TR with rupture of tricuspid valve chordae tendineae caused by LPM implantation.

Preclinical and clinical studies have demonstrated the safety and efficacy of a variable loop circular catheter (VLCC) for Pulsed field ablation (PFA).(1, 2)There are a few studies exploring the safety of the pentaspline PFA catheter in patients with cardiac implantable electronic devices (CIED). (3-5) The safety of the PFA VLCC in this common patient population is so far unexplored because they were excluded from the clinical studies of the VLCC to date.

Leadless pacemakers represent a revolutionary advancement in cardiac pacing, offering a number of advantages over conventional transvenous devices. Many of these advantages lie in the fact that the absence of a pacemaker generator and pacing lead may lead to less pocket and device infections, venous thrombosis and occlusion and tricuspid valve regurgitation and dysfunction. We present a case illustrating an uncommon major complication of severe tricuspid valve regurgitation following leadless pacemaker implant necessitating surgical intervention.