Transvenous leadless pacemaker extraction: When, who, where, and how?

Area of Science:

• Cardiology
• Medical Devices
• Interventional Cardiology

Background:

• Leadless pacemakers offer advantages but pose management challenges at end-of-service or with complications.
• Established transvenous lead extraction methods lack standardization for leadless devices.
• Increasing use of leadless pacing necessitates a structured approach to device removal.

Purpose of the Study:

• To propose a systematic framework for transvenous leadless pacemaker extraction (TLLE).
• To define indications, procedural strategies, risk assessment, and institutional requirements for TLLE.
• To consolidate current knowledge on TLLE for clinical application.

Main Methods:

• Review of existing literature on leadless pacemaker extraction techniques.
• Summarization of clinical indications for TLLE, including device failure, dislocation, infection, and upgrades.
• Analysis of procedural strategies, focusing on femoral access and snare-based techniques, tailored to device specifics.

Main Results:

• High success rates reported in literature for TLLE procedures.
• Identified potential complications include cardiac perforation, tamponade, tricuspid valve injury, and embolization.
• Patient selection and pre-procedural imaging are crucial for decision-making.

Conclusions:

• A structured approach to TLLE is clinically relevant due to increasing leadless pacemaker use.
• Balancing procedural risks with the implications of device abandonment is key for patient management.
• Standardized TLLE protocols are needed to ensure safe and effective leadless pacemaker management.