Atrial leadless device dislodgment and intracardiac echocardiogram (ICE)-guided device retrieval after leadless pacemaker implantation: A case report.

BACKGROUND: Compared to traditional transvenous pacemakers, leadless pacemakers have the advantages of reducing risks of infection, minimal vascular access, and interactions with tricuspid apparatus. However, complications including device dislodgement can still occur and its management requires a comprehensive and innovative approach. We report a case of atrial leadless device dislodgement into pulmonary artery after implantation and intracardiac echocardiogram (ICE)-guided retrieval of the device. Venogram at the area confirmed that the device was lodged into a subbranch of the left pulmonary artery. A gooseneck snare tool was used to snare the device. With ICE guidance, pacemaker and snare device were adjusted to overcome valve entanglement and the system was retrieved. ICE imaging after retrieval showed moderate pulmonary regurgitation (PR) and small circumferential pericardial effusion. The patient tolerated the procedure well and was discharged a week later without any events. Follow-up transthoracic echocardiogram showed improved PR. In conclusion, device dislodgement is one of the complications after leadless pacemaker implantation. Intra-procedural ICE imaging is an efficient tool to guide device retrieval in order to avoid valve entanglement and damage.

LEARNING OBJECTIVE: The management and surveillance of device dislodgment after leadless pacemaker implantation requires an individualized approach. Intra-procedural intracardiac echocardiogram imaging is an efficient tool to guide device retrieval in order to avoid valve entanglement and damage.