Percutaneous retrieval of embolized atrial leadless pacemakers: Early multicenter experience

BACKGROUND: Leadless dual-chamber pacemakers extend pacing into the atrium but introduce unique challenges related to fixation and stability. Atrial device embolization remains poorly characterized, with limited data beyond isolated case reports. OBJECTIVES: To describe the clinical features, procedural characteristics, and outcomes of embolized atrial leadless pacemakers, emphasizing warning signs and percutaneous retrieval strategies. METHODS: We performed a retrospective multicenter case series of AVEIR AR embolization events across 6 United States electrophysiology centers between October 2024 and August 2025. Clinical, procedural, and imaging data were collected, including implant parameters, timing and location of embolization, and retrieval techniques. RESULTS: Six embolization cases were identified (mean age, 71 ± 10 years, 50% women). All devices were implanted at the base of the right atrial appendage with reported minimal or absent current of injury (COI) at implantation. Embolization occurred intraprocedurally in 1 case and during the early postprocedural period in 5 cases, most commonly to the pulmonary arteries (5 of 6 cases). All devices embolized with the fixation helix oriented proximally. Percutaneous retrieval was successful in all cases using femoral access, deflectable sheaths, and snare-based techniques, without major complications. Reimplantation in 2 of 6 cases yielded a robust COI and favorable chronic electrical parameters. CONCLUSION: Atrial leadless pacemaker embolization, although uncommon, appears to occur early after implantation and is associated with suboptimal COI at implant. Despite unfavorable device orientation, percutaneous retrieval using standard electrophysiology tools is highly effective. Careful attention to fixation signals and adjunctive imaging may reduce embolization risk.