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Retrieving Dislodged Leadless Pacemaker With Percutaneous Coronary Angioplasty Balloon-Assisted Snaring: A Novel
Muhammad O Zaman1, Mohammed Hussein1, Andrei Churyla1
1Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA.
Objective:
We present a case of a dislodged atrial leadless pacemaker (LP) snared from the pulmonary artery with the assistance of a percutaneous coronary angioplasty (PTCA) balloon.
Key Steps:
We advanced 2 Judkins right (JR4) catheters through a FlowTriever (Inari Medical) catheter. A PTCA balloon was advanced through the first JR4 catheter and placed distal to the dislodged LP. Gentle traction moved the device proximally; however, it angled away from the Amplatz Goose Neck snare (Medtronic) advanced via the second JR4 catheter. The PTCA balloon was deflated and wedged between the device and the pulmonary vessel wall. Inflating the balloon angled the device toward the snare loop allowing successful snaring and retrieval.
Potential Pitfalls:
Potential pitfalls include an inability to advance a coronary wire across the LP, device encapsulation, distal device migration, and pulmonary artery rupture.
Take-Home Messages:
A PTCA balloon can facilitate dislodged LP retrieval. A multidisciplinary team approach is crucial.
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