Retrieval of a dislodged helix-fixation leadless pacemaker using the double-snare technique: A case report

Abstract

Leadless pacemakers (LPs) reduce the risk of lead-related complications, but early dislodgement remains a rare yet serious adverse event. We report the case of an 88-year-old woman with bradycardia–tachycardia syndrome who underwent implantation of an AVEIR™ VR LP (Abbott, Chicago, IL, USA). The procedure was uneventful, with stable electrical parameters and confirmed fixation. However, pacing failure was detected the following day, and imaging revealed that the device had dislodged into the right pulmonary artery. Given the position and orientation of the dislodged device, the dedicated retrieval catheter was deemed unsuitable. Therefore, the double-snare technique was employed using two snare catheters: one inserted through a steerable sheath to grasp the device body, and the other advanced outside the sheath to secure the helix. This approach enabled safe and complete retrieval without vascular injury. The patient subsequently underwent successful transvenous dual-chamber pacemaker implantation and was discharged without complications. Notably, a small amount of myocardial tissue was found attached to the helix, suggesting possible localized myocardial fragility. This case highlights the utility of the double-snare technique as an effective alternative when standard retrieval tools are inadequate for recovering dislodged LPs.

Learning objective

Leadless pacemaker (LP) dislodgement into the pulmonary artery is a rare but serious complication that requires prompt recognition and appropriate retrieval. The double-snare technique provides a safe and effective option when standard methods are insufficient. Awareness of potential underlying factors, such as localized myocardial fragility, may guide risk assessment and management. Understanding such cases enhances patient safety and supports best practices in LP therapy.