Lessons learned from Micra leadless pacemaker retrieval: a case series

Figure 1. Retrieval in Patient 1. Retrieval of the Micra leadless pacemaker from the right pulmonary artery. The red arrow points to the leadless pacemaker. (A) Access to the right pulmonary artery was obtained using a guide wire and Judkins Right Four catheter. (B) A single-loop snare was used to capture the Micra leadless pacemaker by holding the tines. (C) The Micra leadless pacemaker was pulled into the right ventricle. (D) The Micra was safely withdrawn while being held by the two snares.

Figure 2. Retrieval in Patient 2. Retrieval of the Micra leadless pacemaker with two fractured tines. The red arrow points to the leadless pacemaker. The yellow arrow points to the 2 fractured tines of the leadless pacemaker. (A) A single-loop snare was placed to protect the pulmonary artery. (B) A triple-loop snare was used to capture the Micra leadless pacemaker by holding the retrieval feature. (C) The used Micra leadless pacemaker with only two tines. (D) The other two fractured tines were left in the right ventricular septum, and a new Micra was successfully implanted.

Figure 3. Retrieval in Patient 3. A single-loop snare is used to hold the retrieval feature. The red arrow points to the leadless pacemaker. (A) The Micra was dislodging from its original position with an obvious caudal swing. (B) An attempt was made to retrieve the leadless pacemaker using a single-loop snare, but it was ultimately unsuccessful. (C) A triple-loop snare was placed through a guide wire into the pulmonary artery to minimize the movement amplitude of the leadless pacemaker. (D) The Micra was successfully captured by holding the retrieval feature. (E) Use two snares in coordination to pull the leadless pacemaker into the sheath. (F) A new Micra was successfully implanted in the inferior ventricular septum.

Figure 4. The retrieval tools utilized during the leadless pacemaker retrieval procedure.

Figure 5. Timeline of the four patients.