Mechanical interaction between sequential Micra devices resolved by programming alone: a case of premature battery depletion in a 91-year-old patient

The Micra transcatheter pacing system provides a leadless alternative for patients requiring ventricular pacing. When a leadless device reaches end of service or fails prematurely, a second device is commonly implanted.

We report a 91-year-old man with premature Micra AV battery depletion 28 months after implantation. During the second implantation, mechanically mediated device–device interaction caused intermittent oversensing. Oversensing was resolved by increasing the sensing threshold, which avoided device repositioning or retrieval.

Suspected mechanically mediated interaction between sequential Micra devices may cause oversensing and pacing inhibition. In patients with clinically stable condition and adequate intrinsic R-wave amplitude, programming optimization may be considered before invasive revision; however, future management should account for cumulative right ventricular device burden.