Breaking Frontiers—Leadless Atrial‐Ventricular Hybrid Upgrade to Dual Chamber Leadless Pacemaker

INTRODUCTION: Leadless pacemakers (LP) have significantly reduced device-related complications compared with conventional systems, yet limitations in atrial pacing and atrioventricular (AV) synchrony restrict their widespread use. METHODS AND RESULTS: We report an 87-year-old man with a history of stage 5 CKD on haemodialysis with complete AV block and a previously implanted Micra-AV who developed symptomatic sinus node dysfunction. To restore AV synchrony and avoid transvenous implantation, an Abbott AVEIR AR atrial LP was implanted, achieving functional dual-chamber leadless pacing. The procedure had no complications, and the follow-up demonstrated 89% AV synchrony with symptomatic improvement. CONCLUSION: This case demonstrates the feasibility of achieving a hybrid dual-chamber leadless pacing system from two different manufacturers in selected patients.