Successful leadless pacemaker retrieval from the left pulmonary artery: A case report

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

“…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].…”

“…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 ].…”

“…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 ].…”

“…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 ]. Alternatively, two cases described the utilization of a multipurpose catheter, either in combination with an introducer sheath [ 14 ] or an introducer sheath and a steerable sheath [ 11 ]. In a single case, successful retrieval was possible by using a steerable sheath only [ 10 ]; two further cases did not specify the catheters used.…”

“…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].…”