A place to pace: Multimodal imaging for atrial leadless pacemaker implantation

The recent approval of a leadless atrial pacemaker (ALP, AVEIR™, Abbott, USA) has enabled the benefits of leadless pacing and afforded renewed interest in standalone atrial pacing in patients with isolated sinus node dysfunction. Per manufacturer’s recommendation, implantation is guided by fluoroscopy and contrast injections to first delineate the anatomy of the right atrial appendage (RAA).1 The ALP is ideally implanted at the base of the RAA where adequate myocardial thickness provides a suitable anchor and minimizes the risk of perforation.