Transcatheter Extraction and Implantation of a Novel Leadless Pacemaker via Tricuspid Valve-in-Valve: A Case Report.

BACKGROUND

Transcatheter retrieval of a dislodged leadless pacemaker (LP) from a tricuspid valve-in-valve (ViV) prosthesis has not been previously reported.

CASE SUMMARY: A 42-year-old woman with a prior bioprosthetic tricuspid valve, transvenous pacemaker, and subsequent percutaneous ViV implantation presented with ventricular lead dysfunction. A Micra LP was implanted but dislodged within 7 days. The device was retrieved using a sheath-in-sheath system combined with a double-snare technique under fluoroscopic guidance. The first snare engaged the device, and traction induced tine deformation and device mobilization. After retraction into the right atrium, a second snare enabled coaxial alignment for safe retrieval into the introducer sheath. A new LP was immediately reimplanted with stable electrical parameters that remained satisfactory at 1-year follow-up. No prosthetic valve injury or thromboembolic complications occurred.

CONCLUSION

This case demonstrates that transcatheter retrieval and same-day reimplantation of LP via a tricuspid ViV prosthesis is feasible and safe.