EP News: Case Reports

Leadless pacemaker technologies are emerging as a viable option for pacing that avoids the need for leads and a surgical pocket. The long-term management of these devices is in the process of discovery, in particular the feasibility of extraction. Neužil et al (https://doi.org/10.1016/j.hrcr.2023.01.012) shared the case of an 84-year-old woman with persistent atrial fibrillation and symptomatic bradycardia. In 2012, she underwent implantation of a single-chamber helix-fixation leadless pacemaker (Nanostim; St. Jude Medical Inc, Saint Paul, MN). The device performance was stable for 9 years until in November 2021 it no longer established telemetry consistent with premature battery depletion. The existing Nanostim pacemaker was retrieved using the Aveir Retrieval Catheter (Abbott, Abbott Park, IL), which has a tri-loop snare mechanism, docking cap, protective sleeve, and a high-torque design created to remove the newer-generation Aveir leadless pacemaker (Abbott). The snare was closed around the docking button of the Nanostim pacemaker and then locked, the docking cap mated to the system, and the protective sleeve was advanced over the pacemaker. The snare control handle was rotated counterclockwise while observing rotation of the radiopaque chevron, which freed the device with 3+ rotations. The device was removed without difficulty. Using the same access sheath, a new Aveir VR pacemaker was inserted without difficulty. This case provides insight into the feasibility of the long-term extraction of this leadless pacemaker technology.