SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: A permanent pacemaker (PPM) is an electrical device that is utilized to sustain an appropriate heart rate in individuals who have symptoms, due to bradyarrhythmias, ranging from dizziness, syncope, fatigue, poor exercise tolerance to even death. It is commonly implanted in the pre-pectoral position and connected to transvenous leads through the subclavian vein. Below, we present a case of a patient with Poliomyelitis requiring crutches to ambulate and contraindications to traditional PPM implantation. CASE PRESENTATION: A 72-year old female with history of paroxysmal atrial fibrillation on rivaroxaban, mitral regurgitation and poliomyelitis had been admitted to the hospital with episodes of dizziness, lightheadedness, fatigue and exertional chest pain with heart rate in the 40-50 beats per minute. She underwent cardiac catheterization which did not show significant coronary artery disease. Once she was asymptomatic, she was discharged home on a reduced dose of Carvedilol from 12.5 mg twice a day( bid) to 3.125 mg bid. Her heart rate was still noted to have 40 to 42 bpm upon follow up with a cardiac electrophysiologist (EP) three months post hospitalization. She reported mild exertional dyspnea, so her carvedilol was discontinued and was recommended to have a PPM implanted. The patient had concerns in regards to having a pectoral PPM placed as she relied on the use of crutches to support her during ambulation due to her history of poliomyelitis. The option of having a PPM placed via the femoral vein was discussed along with the rarity of the procedure, risks and benefits. The patient underwent femoral dual chamber device implantation via the right femoral vein and the PPM was placed above the right groin crease down to the pre-external oblique fascia. The patient was discharged after successful interrogation of the device. Her symptoms had resolved on her one month follow up with the EP outpatient. Her pacemaker interrogation revealed 98% atrial pacing. DISCUSSION: Permanent PM is conventionally placed via pectoral approach with contraindications in about 1-6% cases. Alternative approach via femoral approach is a viable option at that time. Some of the advantages would be site availability, lower bleeding risk, ability to perform under local anesthesia. Disadvantages of femoral approach is risk of retroperitoneal hematoma due to erroneous arterial puncture, atrial lead dislodgement. CONCLUSIONS: This case highlights the advantages of PPM placed via femoral vein as it provides an alternate method for individuals who have contraindications to having PPM placed using the traditional route via the subclavian vein. The concern of using crutches and its proximity of the PPM was thus resolved with using this methodology. With the emergence of more case reports highlighting the advantages and success rates of this procedure, PPM placement via the femoral vein may soon become routine practice. Reference #1: •Mathur G, Stables RH, Heaven D, Ingram A, Sutton R. Permanent pacemaker implantation via the femoral vein: an alternative in cases with contraindications to the pectoral approach. Europace. 2001;3:56–59. doi: 10.1053/eupc.2000.0135. Reference #2: •Sutton R, Vardas P. Special surgical techniques in pacemaker implantation, Pacing Clin Electrophysiol, 1987, vol. 10 pg. 749 Reference #3: •Yamaguchi T, Miyamoto T, Yamauchi Y, et al. A case report of successful permanent pacemaker implantation via the iliac vein. J Arrhythm 2016;32:151–3 DISCLOSURES: Consultant relationship with Biosense Webster - Johnsosn & Johnson; Meddtronic Please note: $1001 - $5000 Added 06/02/2020 by Devender Akula, source=Web Response, value=Honoraria no disclosure on file for Rahul Anil; No relevant relationships by Rhea Farquhar, source=Web Response No relevant relationships by URMIL PATEL, source=Web Response