PO-687-06 A CASE OF DIFFICULT LEADLESS PACEMAKER IMPLANTATION DUE TO PACEMAKER DELIVERY SYSTEM FAILURE

Abstract

The Micra leadless pacing system (Medtronic) is an effective alternative to transvenous pacemaker in selected patients and can be safely implanted in > 99% cases. The tether in the delivery system serves as an important connection between the device and the delivery catheter, allowing multiple recaptures to be performed. Failure of the delivery system resulting in inability to deploy is extremely rare. We describe a case of difficult Micra implantation due to leadless pacemaker delivery system failure. N/A An 88-year-old male with complete heart block post transfemoral aortic valve replacement underwent placement of single chamber leadless pacemaker placement (Micra) using standard techniques. Under local anesthesia, access was obtained in the right femoral vein using ultrasound guidance and a 23 French long sheath was inserted and advanced into the right atrium under fluoroscopy. A Micra leadless pacing system was introduced and placed under fluoroscopic visualization into the right ventricular septum. Gentle manual tension on the tether demonstrated good contact with the myocardium. The tether was cut but significant resistance was felt when attempting to remove it. Despite multiple attempts the tether could not be safely removed, and it was decided to extract the Micra system. Unfortunately, despite multiple attempts by applying significant tension on the tether, the delivery catheter would not align with the pacing capsule for safe extraction. At this time it was decided to remove the delivery system leaving the pacing capsule with the tether in place. A 0 Vicryl suture was placed and using a double knot it was secured on a 035 wire and the suture was pulled through a large curve steerable Agilis sheath. Next, the Vicryl and the tether were knotted together and Agilis sheath was advanced to provide additional support and avoid trauma to any internal structure during extraction. Using Agilis as a rail, the Micra was extracted. Gross visual inspection revealed no clear knot on the tether. After the extraction, a new Micra system was placed using standard techniques. It is important to be aware of failure of the components of the leadless pacemaker delivery system and the techniques to safely extract it.