Successful Retrieval of a Dislodged Leadless Pacemaker from the Right Atrium.

Abstract

Background: Leadless pacemakers have been widely adopted for their safety and efficacy in treating bradyarrhythmia. While rare, device dislodgement during implantation necessitates retrieval.

Case report: We present the case of a 91-year-old man with end-stage renal failure receiving maintenance dialysis, who experienced symptomatic complete atrioventricular block. During leadless pacemaker implantation, after multiple unsuccessful attempts to secure the device in the right ventricle, the device dislodged into the right atrium during tether traction. The device initially caught on the tricuspid valve before floating into the posterior right atrium near the inferior vena cava. Using a snare technique, we successfully retrieved the device within 115 minutes of dislodgement. Post-procedure imaging showed no complications. This case highlights that unexpected migration into the right atrium may facilitate safer, simpler retrieval compared to right ventricular or pulmonary artery dislodgement.

Conclusions: The right atrial location offered advantages including reduced cardiac motion influence and fewer premature contractions, enabling easier capture from the inferior vena cava using the snare. Prompt recognition and management of device dislodgement during implantation procedures is of key importance.

Learning points: This report highlights the successful retrieval of a leadless pacemaker that migrated into the right atrium during implantation.Clinicians will learn the importance of prompt recognition of device displacement and how unexpected migration to the right atrium can facilitate safer retrieval, particularly using a snare.Understanding the implications of device migration into the right atrium versus more complex locations, such as the right ventricle or pulmonary artery, is essential for effective management of leadless pacemaker implantation complications.