Successful leadless pacemaker retrieval from the left pulmonary artery: A case report

Perioperative Considerations for Modern Leadless Pacemakers

Since their initial approval by the Food and Drug Administration in 2016, leadless pacemakers have become increasingly prevalent. This growth has been driven by an improved adverse effect profile when compared to traditional pacemakers, including lower rates of infection, as well as eliminated risk of pocket hematoma and lead complications. More recently, technology enabling leadless synchronized atrioventricular pacing in patients with atrioventricular block has vastly expanded the indications for these devices. Anesthesiologists will increasingly be relied upon to safely care for patients with leadless pacemakers undergoing non-electrophysiology procedures and surgery. This article provides an overview of the technology, evidence base, current indications, and unique perioperative considerations for leadless pacemakers.

Percutaneous aspiration and removal of infected leadless pacemaker vegetation

INTRODUCTION

Leadless pacemakers represent an increasingly utilized alternative to traditional pacing methods in those with prior bacteremia or at high risk for infection. The acknowledged resistance to infection is illustrated by the exceedingly rare documentation of it.

METHODS

We present a case of methicillin-sensitive Staphylococcus aureus endocarditis with associated leadless pacemaker infection necessitating percutaneous aspiration of the device-associated vegetation followed by extraction of the leadless pacemaker.

RESULTS

Large vegetation associated with a leadless pacemaker was percutaneously aspirated with a vacuum-assisted aspiration device, followed by successful extraction of the leadless pacemaker.

CONCLUSION

While leadless pacemakers are seldom involved in infective endocarditis, ultrasound evaluation in high-risk patients with an undetermined source is reasonable. Before extraction, it is practical to consider aspiration of large associated vegetations with a vacuum-assisted device.

Lost but Not Lost-Embolization of a Leadless Pacemaker to the Pulmonary Artery with Consecutive Endovascular Recovery

Background: Leadless transcatheter pacemaker systems (TPS) have become a valuable alternative to transvenous pacemakers in selected indications. With the steadily increasing amount of TPS implantations performed worldwide, reports of periprocedural complications are likewise increasingly found in the literature but are still underreported. Case presentation: We report a case of a 75 year old male undergoing TPS implantation due to cardioinhibitory vasovagal syncope. The implantation was primarily uneventful; adequate pacing parameters and fixation of the device were achieved. Unfortunately, dislocation of the leadless pacemaker occurred at the end of the procedure and the device embolized into a primary side branch of the right pulmonary artery. Endovascular retrieval was performed by using a single snare technique without any further complications. Conclusions: Although challenging, endovascular recovery of embolized TPS from the pulmonary artery is feasible and may be successfully accomplished by experienced implanters.