Safety and efficacy of leadless pacemaker retrieval

Abstract

Background and Objectives The success rate of leadless cardiac pacemaker (LP) retrieval remains a major concern for this disruptive technology. The present paper performed a systematic review of the safety and feasibility of the retrieval of LPs. Methods Primary publications that performed LP retrieval were collected and included five animal experiments and two worldwide retrieval experiences in human. The procedural details, such as indication, days post implantation, extraction success rate, and complications, were described. The present paper analyzed factors affecting the retrieval and management of the nonfunctional devices. Results Retrieval animal models was possible at least up to 2.5 years post implantation, and data from humans suggest that removal of a device that was implanted longer (eg, 4 years and 9 months for Nanostim; 4 years for Micra) could be performed within a reasonable safety profile. The fixed mechanism, implant site, and encapsulation of the LP systems may affect the retrieval process. Conclusions A high success rate in the relatively chronic retrieval of LPs was demonstrated, which promotes the extensive use of these devices in the treatment arrhythmia in the future.

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

“…4 Successful retrieval from the septal location has been described using the Micra transcatheter pacing system (TPS) (Medtronic Inc, Minneapolis, MN) introducer sheath, a Micra delivery catheter, or a steerable sheath that allows better alignment with the device and a loop snare. 5 However, retrieval from high septal locations or the pulmonary artery can be challenging given the lack of support and coaxial positioning. Some clinicians may advocate to abandon the device in the absence of symptoms.…”

Simultaneous infection of abandoned leads and newly implanted leadless cardiac pacemaker: Why did this occur?

“…Regarding the treatment, three instances of successful Nanostim leadless pacemaker (Abbott Laboratories, Abbott Park, IL, USA) extractions were reported from a single center [9]. Li et al described that CIED retrieval in animal models was possible up to at least 2.5 years post-implantation [10]. Thus, we extracted the MICRA1 using an Osypka snare catheter.…”

The importance of leadless pacemaker positioning in relation to subcutaneous implantable cardioverter-defibrillator sensing in completely leadless cardiac resynchronization and defibrillation systems

“…Even small changes in device placement may lead to suboptimal ICD sensing, as in this case. Extraction of existing leadless pacemakers is feasible, with a high success rate and low risk of complications, 16 and may be preferable in such cases, to allow implantation of replacement devices in a similar position to the original. However, myocardial damage at the extraction site may have implications for implantation of a replacement device, including high pacing thresholds or risk of perforation.…”