TY - JOUR
AU - Mitani, H
AB - Case: The patient is a 86-year-old man with symptomatic bradycardia atrial fibrillation. He was performed his 2nd replacement of the generator 11 years ago, who originally underwent the pectoral implantation of the 1st pacemaker in 1991. During device follow-up, the ventricular lead parameters were functioning normally, approximately 70% ventricular pacing had been required from 11 years ago. But sometimes sensing and pacing troubles occurred due to system using a unipolar lead. Battery voltage level became ERI, and we elected to proceed with placement of a single-chamber leadless pacemaker. The leadless pacemaker was inserted via a right femoral venous approach, advanced through the inferior vena cava into the right atrium, across the tricuspid valve and was placed in the right ventricle using the introducer and the delivery system. After several attempts, the pacemaker was deployed successfully on the anterior septum, and had 3 of the 4 tines engaged in the tissue by the pull and hold test. The electrical measurements of impedance, R-wave amplitude, and pacing threshold were acceptable. After the tether was cut, I felt a little resistance and gently pulled the tether out of the delivery system under fluoroscopy. To complete the procedure, the delivery system was removed from the introducer, and the electrical measurements were tested again. The pacing threshold became highly unstable and the lack of stability lasted over 30 minutes. We decided to remove the device percutaneously, by using a snare catheter, and a steerable introducer. As expected, snaring the retrieval head of the leadless pacemaker was challenging because the retrieval head was too close to septum. Using an electrode catheter and another steerable introducer via a left femoral venous approach, we attempted to turn the device in some other direction, so that the retrieval head was accessible for the snare catheter. In the next instant, the leadless pacemaker had dislodged from the right ventricle and embolized to a branch of the left pulmonary artery. The device was stuck in the left pulmonary artery, and the retrieval head was pointing distally. The patient was entirely asymptomatic and hemodynamically stable, as there was no occlusion of the pulmonary artery. Using the snare catheter, a multipurpose catheter, and the steerable introducer via a left femoral venous approach, we snared 2 of the 4 tines of the leadless pacemaker (Figure 1), the device was gently pulled from the left pulmonary artery to the right atrium through the pulmonary valve and the tricuspid valve. Finally, we snared the retrieval head with another snare device and successfully retrieved into the 27-Fr introducer in the inferior vena cava without any complication.(Figure 2) Conclusion: We report successful retrieval of a leadless pacemaker embolized and stuck in the pulmonary artery with combined use of a multipurpose catheter and snare devices. Open in new tabDownload slide Abstract P940 Figure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2018. For permissions please email: Journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2018. For permissions please email: Journals.permissions@oup.com.
TI - P940Retrieval of leadless pacemaker embolizes to the lungs
JF - Europace
DO - 10.1093/europace/euy015.541
DA - 2018-03-01
UR - https://www.deepdyve.com/lp/oxford-university-press/p940retrieval-of-leadless-pacemaker-embolizes-to-the-lungs-ewLKfdIkIB
SP - i185
EP - i185
VL - 20
IS - suppl_1
DP - DeepDyve
ER -