A leadless pacemaker is a pacemaker that does not have vascular leads. The “Micra” leadless pacemaker (MicraTM, Medtronic Japan Co., Ltd.) was introduced into clinical practice in Japan in 2017. Here, we report perioperative management of a patient with a previously implanted leadless Micra pacemaker. The location of the pacemaker in the body could not be detected from body surface findings since the Micra is implanted in the right ventricle cavity. Successful perioperative management in this case was achieved using the following four steps before induction of general anesthesia: 1) confirmation of the maximum intensity point of communication between the Micra and the controller on the episternum using the color of a light-emitting diode on the controller head, 2) confirmation that the Micra functioned as a ventricular stimulation fixed-rate pacemaker, 3) attachment of transcutaneous pacing/defibrillation pads to the patient to enable emergency electrical therapy for potentially fatal arrhythmia, and 4) continuation of ventricular inhibited pacing.
