A novel technique for extraction of a leadless pacemaker that embolized to the pulmonary artery in a young patient: A case report

Late extraction of an embolized leadless pacemaker from the right pulmonary artery

“…While device dislodgement is usually post-procedural, it may occur within hours to days but rarely occurs later. [4][5][6][7]. The Micra embolization to the branches of the pulmonary artery can be severe, resulting in pulmonary artery obstruction, acute respiratory failure, cardiac tamponade, cardiac perforation, and sometimes, death.…”

Lost but Not Lost—Embolization of a Leadless Pacemaker to the Pulmonary Artery with Consecutive Endovascular Recovery

“…Feasibility of endovascular recovery of a dislocated and/or embolized TPS has been previously demonstrated in case reports for all currently (Micra ® , Wireless stimulation endocardial system (WiSE-CRT ® ); EBR Systems Inc., Sunnyvale, CA, USA) and formerly (Nanostim ® , St. Jude Medical) available leadless pacing systems, but these procedures are described as challenging [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Dislocated right-sided devices (Micra ® , Nanostim ® ) mostly embolize into the pulmonary arteries, affecting either side (left vs. right) with its corresponding branches equally often [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Two cases with floating devices have been described; one of them was the result of an attempted retrieval and subsequent dislocation to the right atrium [ 16 ], the other TPS was floating between right ventricular apex and tricuspid valve, resulting in repetitive non-sustained ventricular tachycardias [ 17 ].…”

“…Similar to our case, most devices were retrieved by using a single snare technique [ 8 , 9 , 10 , 11 , 12 ]. Alternatively, double snare techniques have been described to be successful as well [ 13 , 14 , 15 , 16 , 17 , 18 ], especially in cases of floating devices [ 16 , 17 ].…”

“…A low complication rate has been reported in large trials [4], however, there is high demand for related literature as they still might occur. Feasibility of endovascular recovery of a dislocated and/or embolized TPS has been previously demonstrated in case reports for all currently (Micra ® , Wireless stimulation endocardial system (WiSE-CRT ® ); EBR Systems Inc., Sunnyvale, CA, USA) and formerly (Nanostim ® , St. Jude Medical) available leadless pacing systems, but these procedures are described as challenging [8][9][10][11][12][13][14][15][16][17][18][19]. Dislocated right-sided devices (Micra ® , Nanostim ® ) mostly embolize into the pulmonary arteries, affecting either side (left vs. right) with its corresponding branches equally often [8][9][10][11][12][13][14][15].…”

“…Specifically, the tines should be caught with one snare and the retrieval feature grasped after fixation as a second step. By doing so, the tines of the TPS are then released before the device is reinserted into the introducer sheath [13][14][15][16][17][18]. Regarding the choice of catheters, most procedures have been conducted by either using a combination of a Micra ® introducer sheath with an angiographic catheter [9,15], a steerable sheath [16,18], or both [17].…”