Workflow for removal of dislodged leadless pacemaker from distal pulmonary artery: A case report

Figures

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  Figure 1. Electrocardiogram shows atrial fibrillation with an extremely slow heart rate in 20s.

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  Figure 2. A: Right anterior oblique view showing initial dislodgement of the pacemaker in the right ventricular outflow tract before further dislodgement by the Aveir removal snare. The dislodged leadless pacemaker (LP) is in the right ventricular outflow tract (black arrowhead). The dialysis catheter (white arrowhead) can also be appreciated. B: Shallow left anterior oblique view showing an LP dislodged into the left pulmonary artery. An LP can be seen in the distal branch of the left pulmonary artery (black arrow). Abbott Aveir recovery tool is also seen (white arrow).

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  Figure 3. A: A right Judkins catheter is used to steer a 180 cm J-tipped guidewire toward the dislodged leadless pacemaker in the right ventricular outflow tract. B: Deployment of a trileaflet snare; the snare has successfully captured the device by the distal helix. C: Fluoroscopy showing retrograde retrieval of the leadless pacemaker into the femoral vein. A 0.035 in glide wire is maintained alongside to preserve venous access for subsequent reimplantation. D: Postprocedural inspection confirming the snare’s entrapment of the helix, which resulted in the device being secured at an angle external to the sheath tip.

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  Figure 4. Equipment used to remove the leadless pacemaker: right Judkins catheter (A), trileaflet snare (B), magnified trileaflet snare (C), and 180 cm J wire (D).