PO-02-053 CHRONIC RETRIEVAL OF NANOSTIM ™ LEADLESS PACEMAKER (LP) FOR RIGHT VENTRICULAR PACING

Abstract

Leadless cardiac pacemakers (LCPs) are an effective and safe alternative to transvenous pacemakers for single-chamber ventricular pacing. Feasibility of retrieving and replacing long-term implanted LCPs is not well established. We report a small single center series of chronically implanted Nanostim LCP™ leadless pacemakers. Since 2012 there were 103 Nanostim LCP™ devices implanted successfully to the right ventricle (RV) position. In 45 patients (M 26/ F 19), Ø age 72,5± 17 years, with average time since LCP implant of 15470 ± 479 days retrieval procedure was indicated. The main indication for LCP extraction was battery depletion indicative of a battery chemistry issue. Under fluoroscopy we observe the movement and location of LCP. Single snare (42) or triple snare (3) retrieval catheter was introduced through right femoral venous puncture. With deflection we snare the docking bottom and apply counter-clockwise rotation to release the LCP from tissue insertion.Besides fluoroscopy we guided the retrieval procedure with intracardiac echocardiography (ICE). The retrieval procedure was successful in 39 out of 45 patients (86,6%). Average time of the index retrieval procedure was 57 ± 21 minutes and average fluoroscopy time was 11.6 ± 5.2 minutes. New LP system was implanted in 37 patients during the same procedure. When the “swinging” LCP movement was observed, then we were able to retrieve (31 out of 31 patients (100%) vs restricted movement 7 out of 14 patients (50%); p < 0.001. Fluoroscopy time was as well shorter with “swinging” LCP movement (12.7 ± 8.6 min) vs restricted movement (45.6 ± 19 min); p < 0.001. This single center retrieval experience demonstrates the feasibility of replacement long-term implanted Nanostim LCP. The screw-in mechanism and dedicated