Inadvertent Left Ventricular Implantation of a Leadless Pacemaker Managed by Percutaneous Extraction
Jonathan Schilling1, Leili Pourafkari1, Ali Sovari2
1Department of Cardiology, HCA Los Robles Regional Medical Center, Thousand Oaks, California, USA.
Background:
Although leadless pacemakers minimize lead- and pocket-related complications, their implantation requires a precise technique to avoid rare but serious malposition events.
Case Summary:
We present an 84-year-old woman with inadvertent left ventricular (LV) implantation of an Aveir leadless pacemaker. The device was successfully extracted using a carefully executed double-snare technique, followed by new device implantation in the right ventricle.
Discussion:
There is limited literature guiding the management of inadvertent LV leadless pacemaker implantation, particularly regarding anticoagulation and safe extraction strategies. This case highlights key considerations and demonstrates a successful approach to device removal.
Take-Home Messages:
As the use of leadless pacemakers increases, so does the potential for related complications, including inadvertent LV implantation. Using multiple fluoroscopic projections during implantation can help ensure correct right ventricular positioning. If LV placement occurs, management-including consideration of anticoagulation and tailored extraction strategies-should be individualized to reduce thromboembolic risk.
