Introduction
The MTPS is an expanding technology that has been proved to be safe and effective both in investigational studies and real world setting. MTPS has been developed to address the limitations of standard transvenous leads-based pacing, by virtually eliminating lead - and pocket-related complications.
As a consequence, the population that should be expected to benefit the most from a leadless pacemaker (LP) is that with a higher risk of device infection. In addition, LP may offer a significant advantage over traditional leads based pacing in case of severe venous obstruction of subclavian veins/superior vena cava preventing pacing lead insertion1,2. Anyway, facing these pathological conditions may open an unexplored and challenging operative scenario. We report on a patient requiring pacemaker implantation, due to third degree atrioventricular block, and with a paraneoplastic chronic thrombosis of the superior vena cava infiltrating the right atrium and precluding the implantation of a traditional pacemaker.