Late Retrieval of the Leadless Micra Transcatheter Pacemaker System

Kentaro Minami

doi:10.31579/2641-0419/138

Abstract

Aim: We report our single-center experience with the retrieval and replacement of the chronically implanted Micra transcatheter pacing system (TPS). Material and Methods: We included 6 patients with an implanted the Micra TPSs who subsequently underwent transvenous method of retrieval at our institution. The indication for device retrieval was pacemaker syndrome in two patients, battery depletion in three patients, and need for upgrade to biventricular pacing in one patient. Results: After an implantation duration of 555 ± 373 days, the overall retrieval success rate was 83.3%, 5 of 6 patients. No procedure-related adverse device events occurred. In the single patient with unsuccessful retrieval, intracardiac echocardiography revealed that the Micra TPS was embedded within the cardiac wall and surrounding tissue. After retrieval, four patients received a new Micra TPS. Conclusions: Late retrieval of an implanted Micra TPS was safe and feasible, which indicates the possibility for their safe and elective replacement with a new leadless pacing device.

Highlights

Leadless cardiac pacemakers (LCPs) are safe, effective alternatives to conventional transvenous pacemakers for patients who require singlechamber ventricular pacing [1,2]
With an alternative LCP of different size and shape, it has been demonstrated that retrievability is possible even after implant durations of up to 6 years, with success rates ranging between 8090% [4,5,6]
That LCP was removed from clinical use because of a battery dysfunction, and its longer and thinner profile precludes one from extrapolating from this experience to the feasibility, safety or efficacy of transcatheter pacing system (TPS) retrievability

Summary

Introduction

Leadless cardiac pacemakers (LCPs) are safe, effective alternatives to conventional transvenous pacemakers for patients who require singlechamber ventricular pacing [1,2]. The Micra transcatheter pacing system (TPS) (Medtronic, Minneapolis, MN, USA), which is currently the only commercially available LCP for clinical practice, exhibited a high implantation success rate and stable pacing performance in global prospective studies [3]. Despite these promising results, the ability to retrieve a long-standing implanted TPS may be a useful management strategy in certain scenarios. With an alternative LCP of different size and shape, it has been demonstrated that retrievability is possible even after implant durations of up to 6 years, with success rates ranging between 8090% [4,5,6]. We report our single-center clinical experiences regarding the retrieval of chronically implanted Micra TPS

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Methods

Conclusion