Tether Entrapment and Fracture Preventing Release and Redocking of a Helix-Fixation Atrial Leadless Pacemaker: Successful Resolution With a Protective Sleeve-Assisted Bailout Maneuver.

BACKGROUND

Helix-fixation dual-chamber leadless pacemakers reliably provide bradycardia pacing, yet mechanical complexity of the delivery system can rarely lead to procedural failure.

CASE PRESENTATION: During atrial leadless pacemaker implantation, resistance felt when transitioning to tether mode suggested tether entrapment within a damaged torque shaft, resulting in mechanical distortion or fracture and preventing both device release and redocking. A controlled bailout maneuver-advancing the protective sleeve near the helix and rotating the entire catheter system counterclockwise-enabled safe unscrewing and withdrawal without complications.

CONCLUSION

This report describes a previously unreported tether-related malfunction and a practical maneuver for resolving this failure mechanism.