Key result
Protective sleeve-assisted retrieval enables safe extraction of a migrated leadless pacemaker from pulmonary artery.
Why the study?
Leadless pacemaker migration into the pulmonary artery is an exceptionally rare and serious complication, and tail-first migration poses risks of vascular injury during traction on the exposed helix.
Does a protective sleeve-assisted helix-side retrieval strategy safely remove a tail-first migrated leadless pacemaker from the pulmonary artery in a patient with bradycardic atrial fibrillation?
Case Report (n=1)
No
Does a protective sleeve-assisted helix-side retrieval strategy safely remove a tail-first migrated leadless pacemaker from the pulmonary artery in a patient with bradycardic atrial fibrillation?
A protective sleeve-assisted retrieval technique provides a feasible and safe bailout option for tail-first pulmonary artery migration of a leadless pacemaker when the docking button is inaccessible.
Answers are grounded in this paper and cite their sources.
May offer bailout for rare leadless pacemaker migration; extends case reports but leaves open generalizability and safety.
Background Leadless pacemaker migration into the pulmonary artery is an exceptionally rare but potentially serious complication. Tail-first (proximal helix–oriented) migration poses additional risk, as traction on the exposed helix may cause vascular injury. Case summary A 72-year-old woman with bradycardic atrial fibrillation underwent implantation of an Aveir™ VR leadless pacemaker. Immediately after device release, fluoroscopy revealed a tail-down shift suggesting inadequate mechanical engagement, accompanied by frequent premature ventricular contractions and non-sustained ventricular tachycardia, prompting immediate retrieval. During the retrieval procedure, the device became completely dislodged and migrated into the left pulmonary artery with the helix oriented proximally. In this orientation, standard docking button retrieval was not feasible. The Aveir™ retrieval catheter was advanced into the pulmonary artery, the helix was captured, and the device was enclosed within the protective sleeve before successful extraction. The new device was subsequently re-implanted at a more apical septal site, and stable fixation was achieved. Discussion In previously reported cases of pulmonary artery migration of the Aveir™ pacemaker, retrieval was performed using non-dedicated flexible sheaths and snare catheters. In contrast, this case demonstrates that advancing the dedicated retrieval system to enclose the grasped helix enabled controlled retrieval while minimizing direct contact between the exposed helix and the pulmonary arterial wall. This case also highlights that satisfactory electrical parameters alone may not guarantee adequate mechanical fixation. Although this technique may represent a practical bailout strategy when engagement of the docking button is not feasible, further clinical experience is required to establish its safety and reproducibility.
No takes yet. Share an insight, caveat, or question.
Yasuoka et al. (2026) conducted a case report in Bradycardic atrial fibrillation (n=1). Protective sleeve-assisted helix-side retrieval strategy was evaluated on Successful retrieval of migrated leadless pacemaker. A protective sleeve-assisted helix-side retrieval strategy enabled the successful and safe extraction of a tail-first migrated leadless pacemaker from the pulmonary artery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: