Key result
Snare technique safely extracts a depleted leadless pacemaker at 23 months without relevant adhesions.
Case Report (n=1)
This case demonstrates the feasibility and safety of extracting a leadless pacemaker 23 months post-implantation using a snare technique, noting a lack of significant adhesions.
Successful implantation despite variable thresholds supports feasibility in amyloid cardiomyopathy; leaves open durability questions for prospective study.
A 78-year-old man suffering from symptomatic bradycardic permanent atrial fibrillation with syncope in the setting of amyloid-associated cardiomyopathy underwent uncomplicated implantation of a leadless pacemaker [Medtronic Micra Transcatheter Pacing System (TPS), Medtronic, Minneapolis, MN, USA]. Although successful in the end, slightly elevated pacing thresholds were observed in several regions of the right ventricle. Ultimately, a mid-septal position with a threshold of 1.13 V @ 0.24 ms was accepted. After an initial stable course, pacing thresholds steadily increased over time and the battery depleted after 23 months. We decided to extract the existing Micra pacemaker and replace it with a conventional transvenous VVI pacemaker. A Micra delivery sheath (23 Fr) was advanced to the right atrium via a right femoral access. A steerable large-curl 8.5-Fr sheath (Agilis NxT, Abbott, IL, USA) was advanced to the right ventricle via the Micra delivery sheath. A 6-Fr Amplatz Goose Neck Snare (25 mm, Medtronic) was placed over the body of the Micra pacemaker (Panel A, Supplementary material online, Video S1). From there, the loop was closed and pulled back to engage the proximal retrieval feature of the device (Panel B, Supplementary material online, Video S2). The device could be removed safely from the right ventricular wall by gentle manual traction and pulled back into the right atrium (Supplementary material online, Video S3), and removed from the body (Supplementary material online, Video S4). A thorough inspection of the extracted device demonstrated nearly no adhesions surrounding the pacemaker including the nitinol tines (Panel C). Amplatz Goose Neck loop (25 mm) snaring the body of the Micra device (Panel A). Snare pulled back to the proximal retrieval feature (Panel B). The extracted leadless pacemaker without relevant adhesions surrounding the body or tines (Panel C). A.B. has received consultant and/or speaker fees from Abbott, Bayer, Biosense Webster, Biotronik, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Novartis, and Spectranetics/Philipps. A.M.S. has received educational grants from Abbott, Biosense Webster, Biotronik, Boston Scientific, and Medtronic. D.H. reports educational grants and/or speaker fees or fellowship support from Abbott, Bayer, Biosense Webster, Biotronik, Boston Scientific, Medtronic, and Novartis. J.S. has received consultant and/or speaker fees from Abbott, Amgen, Astra-Zeneca, Atricure, Bayer, Biosense Webster, Biotronik, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Medscape, Medtronic, Merck/MSD, Novartis, Pfizer, Sanofi-Aventis, WebMD, and Zoll. He reports ownership of CorXL. J.S. has received grant support through his institution from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, and Medtronic. Supplementary material is available at European Heart Journal online.
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Breitenstein et al. (2019) conducted a case report in Symptomatic bradycardic permanent atrial fibrillation with syncope and amyloid-associated cardiomyopathy (n=1). Extraction of a leadless pacemaker (Medtronic Micra) was evaluated on Successful extraction of the device. A depleted leadless pacemaker was successfully and safely extracted 23 months after implantation using a snare technique, with no relevant adhesions observed.
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