Transjugular Leadless Pacemaker in a Preschool Child With Nickel-Titanium Allergy

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BACKGROUND: Leadless pacemakers (L-PMs) have limited clinical application in low-weight young pediatric patients. Conventional transvenous pacemakers carry infection/allergy risks, with no established L-PM implantation protocols for metal-allergic pediatric populations. CASE SUMMARY: A 4-year-old child with third-degree atrioventricular block had previously undergone 3 failed transvenous pacemaker implantations, each complicated by poor incisional healing and skin ulceration of the subcutaneous pockets. Patch testing confirmed metal allergy. A leadless single-chamber pacemaker (Micra VR, Medtronic) was successfully implanted via the right internal jugular vein. DISCUSSION: Pediatric metal allergy to pacemaker casings is rare, and conventional pacing is unfeasible in such cases. Literature on transjugular L-PM implantation in low-weight children with nickel-titanium allergy is scarce, with no standardized venous access or procedural approaches reported. TAKE-HOME MESSAGE: Transjugular L-PM implantation is a viable alternative for low-weight pediatric patients with pacemaker metal allergy and failed conventional pacing, providing a critical technical pathway for this high-risk population.

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