Percutaneous Retrieval of a Micra™ Leadless Pacemaker Using a One-tine-based Snaring Technique: The Tine Is Durable but Maybe It Should Be the Last Resort.

Micra™ retrieval techniques involve snaring the proximal knob; however, device orientation can hinder knob access. Unorthodox retrieval methods included a two-snare approach and a "snare-in-snare" technique. We describe a single-tine-based snaring approach of a Micra™ leadless pacemaker (Medtronic, Minneapolis, MN, USA) 4 days after implantation due to loss of capture. An 89-year-old man with a history of chronic kidney disease, hypertension, and transcatheter aortic valve replacement complicated by complete heart block underwent Micra™ implantation. Four days later, he presented with syncope. Interrogation showed an elevated capture threshold with intermittent loss of capture. Chest radiography confirmed an upside-down orientation in the right ventricular outflow tract. A 27-Fr outer-diameter Aveir™ Introducer Sheath (Abbott, Chicago, IL, USA) was advanced via the right femoral vein. The Aveir™ leadless pacemaker (Abbott) was implanted in a lower septal position. Multiple attempts to snare the Micra™ device's retrieval knob using the Aveir™ Retrieval Catheter (Abbott) and a Goose Neck Snare (20-mm loop diameter, 102 cm; Covidien [Medtronic], Dublin, Ireland) through a steerable sheath failed. A figure-of-eight stitch was placed around the introducer sheath and left untied. The snare engaged a partially free tine. Gentle traction confirmed secure engagement, and controlled traction disengaged the remaining tines. The device was withdrawn into the inferior vena cava but could not be pulled into the sheath due to angulation. The entire system was removed, and the groin stitch was tied. However, the Micra™ dislodged into the groin subcutaneous tissue. Iliofemoral angiography via internal jugular vein access confirmed no extravasation, and the device was explanted through a small groin incision using forceps. Percutaneous retrieval of a Micra™ leadless pacemaker, with short dwell time, is feasible using a one-tine-based snaring technique when snaring of the proximal retrieval knob fails. The tine is durable; however, caution should be exercised.