Segmental Snare Traction Technique for Helix‐Fixed Leadless Pacemaker Implantation Across a Repaired Tricuspid Annulus

Helix-fixed leadless pacemaker delivery can be challenging after tricuspid annuloplasty with a rigid ring. An 80-year-old woman with prior mitral valve repair, tricuspid annuloplasty (26-mm MC ring), and Maze III surgery presented with syncope due to atrial fibrillation with a slow ventricular response. Standard maneuvers failed to advance the Aveir VR delivery system across the repaired annulus, and simple distal snare traction crossed the ring but could not secure a stable septal trajectory. A three-step segmental snare traction technique enabled controlled annular crossing and inferior septal fixation with preserved tricuspid valve function at 1 year.