Successful removal of a leadless pacemaker from the pulmonary artery via a novel basket retrieval system

Key Teaching Points•Leadless pacemakers are an alternative to traditional pacemakers, with fewer complications related to venous stenosis, infection, or valve impingement. These pacemakers carry a risk of dislodgement and embolization into the pulmonary arteries. It may be necessary to remove these devices endovascularly.•It is preferable to capture these devices into a sheath in the pulmonary artery in order to protect the pulmonary and tricuspid valves from the nitinol tines used to secure the device in the right ventricle. Traditional strategies use snaring techniques and a large sheath for safe retrieval. Snaring via the distal flange and/or nitinol tines is effective but not always possible, and alternatives to this strategy must be considered for complex retrieval cases or difficult anatomic positioning of the embolized device.•Retrieval of dislodged leadless pacemakers should be performed as soon as possible after recognition of dislodgement. Facilities that place leadless pacemakers should have the necessary personnel and equipment for retrieval at the time of placement.•A tug test should be performed during placement of Micra leadless pacemakers prior to deployment to reduce the risk of dislodgement and embolization.•A multidisciplinary approach between specialties is important for difficult pacemaker retrieval cases. Multiple strategies from each discipline were employed that ultimately resulted in successful retrieval of the Micra via the use of a novel basket retrieval catheter. •Leadless pacemakers are an alternative to traditional pacemakers, with fewer complications related to venous stenosis, infection, or valve impingement. These pacemakers carry a risk of dislodgement and embolization into the pulmonary arteries. It may be necessary to remove these devices endovascularly.•It is preferable to capture these devices into a sheath in the pulmonary artery in order to protect the pulmonary and tricuspid valves from the nitinol tines used to secure the device in the right ventricle. Traditional strategies use snaring techniques and a large sheath for safe retrieval. Snaring via the distal flange and/or nitinol tines is effective but not always possible, and alternatives to this strategy must be considered for complex retrieval cases or difficult anatomic positioning of the embolized device.•Retrieval of dislodged leadless pacemakers should be performed as soon as possible after recognition of dislodgement. Facilities that place leadless pacemakers should have the necessary personnel and equipment for retrieval at the time of placement.•A tug test should be performed during placement of Micra leadless pacemakers prior to deployment to reduce the risk of dislodgement and embolization.•A multidisciplinary approach between specialties is important for difficult pacemaker retrieval cases. Multiple strategies from each discipline were employed that ultimately resulted in successful retrieval of the Micra via the use of a novel basket retrieval catheter.