Key result
Percutaneous extraction using dual steerable introducers and snares successfully retrieves a dislocated Micra pacemaker.
Why the study?
Leadless pacemaker dislocation and extraction have been rarely reported despite increasing implantation rates worldwide.
Can a dislocated leadless pacemaker be successfully extracted percutaneously?
Case Report (n=1)
Can a dislocated leadless pacemaker be successfully extracted percutaneously?
Percutaneous extraction of a dislocated leadless pacemaker is challenging but feasible using steerable introducers and snare catheters.
Supports feasibility in select cases; hypothesis-generating and requires prospective validation before wider adoption.
BACKGROUND: Leadless pacemaker implantation rates are increasing worldwide. Until now leadless pacemaker dislocation and extraction has been rarely reported. CASE SUMMARY: An 83-year-old patient with cardiac amyloidosis, chronic atrial fibrillation, and complete heart block was implanted with a leadless pacemaker (Micra, Medtronic). On the day after implantation, the device showed an exit block and on cardiac echocardiography and cardiac computer tomography, a device dislocation could be detected. During the day, the device moved at least three times between the tricuspid valve and the right ventricular apex. Each time causing non-sustained ventricular tachycardia. At the next day device extraction was scheduled. After 189 minutes of procedure time, it was possible to retrieve the device with the help of two steerable introducers (Agilis) and two snare catheters. DISCUSSION: Implantable transcatheter leadless pacemakers can be implanted safely most of the time. However, in rare cases device dislocations may occur. Device extraction is possible, but is described as challenging in most published cases 10.1093/ehjcr/ytz113_audio1 ytz113_audio1 6074457264001.
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Fichtner et al. (2019) conducted a case report in Leadless pacemaker dislocation (n=1). Percutaneous extraction of a leadless Micra pacemaker was evaluated on Device extraction success. Percutaneous extraction of a dislocated leadless Micra pacemaker was successfully performed in an 83-year-old patient using two steerable introducers and two snare catheters over 189 minutes.
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