Leadless pacemaker implantation (LPI) has fewer device complications and reduced chance of infection compared to conventional pacemakers. Dextrocardia with situs viscerum inversus (DC+SVI) is a rare condition, which seldom leads to cardiac complications. However, its presence poses a challenge to operators in cardiac procedures. LPI reports in DC patients are scarce. We report a case of LPI in a DC+SVI patient, followed by a brief but comprehensive literature review.

Recent developments in arrhythmology have enabled the use of new devices, such as subcutaneous implantable cardioverter-defibrillators (s-ICD), and the comeback of older strategies, such as His-Bundle pacing (HBP) in clinical practice, alongside the use of thoroughly proven therapies such as cardiac resynchronization therapy (CRT), e.g. with His-Optimized CRT (HOT-CRT). However, interplay between these new and older techniques is not always clear. We report the first-in-human case of biventricular pacemaker (CRT-P) implantation with HOT-CRT in an s-ICD patient. Paced QRS morphology was similar to the spontaneous morphology, albeit shorter. Correct QRS identification by the s-ICD was confirmed both intra-procedurally and post-procedurally.