Leadless pacemaker retrieval from the left pulmonary artery in a patient with left persistent vena cava: a case report

From Top Italian Scientists Journal
Published
September 1, 2025
Title
Leadless pacemaker retrieval from the left pulmonary artery in a patient with left persistent vena cava: a case report
Authors
Anna Sirignano, Rita Di Rosa, Marco Petrassi, Roberta Albanesi, Giuseppe Biondi-Zoccai, Francesco Versaci.
Keywords
Leadless pacemaker; Device dislodgement; Pulmonary artery retrieval; Persistent left superior vena cava; Percutaneous extraction.
DOI
10.62684/UAZG9928
Downloads
Download PDF
Download PDF

Anna Sirignano (a), Rita Di Rosa (a), Marco Petrassi (a), Roberta Albanesi (a), Giuseppe Biondi-Zoccai (b,c), Francesco Versaci (a).

(a) Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy

(b) Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

(c) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy


Correspondence to: Dr. Anna Sirignano, Division of Cardiology, Santa Maria Goretti Hospital, Via Lucia Scaravelli, 04100 Latina, Italy. Email: an.sirignano@gmail.com


Abstract

Leadless pacemakers (LPMs) represent an important advancement in cardiac pacing, particularly for patients with venous access limitations or a history of device-related complications. Although implantation techniques are standardized, percutaneous retrieval of LPMs remains a challenging and rarely performed procedure. We present the case of an 85-year-old male with persistent left superior vena cava (PLSVC) and multiple prior pacemaker interventions, who presented with leadless pacemaker dislodgement into a peripheral branch of the left pulmonary artery. The device was successfully retrieved percutaneously using a transfemoral approach involving two different-sized snares and a deflectable catheter system, overcoming significant technical challenges and secondary migration into the dilated coronary sinus. This case underscores the considerable procedural issues of LPM retrieval in complex anatomical settings and highlights the importance of tailored interventional strategies to ensure safe device extraction.

Declarations

Acknowledgements

This manuscript was drafted with the assistance of artificial intelligence tools, such as ChatGPT 4 (OpenAI, San Francisco, CA, USA), Mage (Mage, New York, NY, USA), in keeping with established best practices (Biondi-Zoccai G, editor. ChatGPT for Medical Research. Torino: Edizioni Minerva Medica; 2024). The final content, including all conclusions and opinions, has been thoroughly revised, edited, and approved by the authors. The authors take full responsibility for the integrity and accuracy of the work and retain full credit for all intellectual contributions. Compliance with ethical standards and guidelines for the use of artificial intelligence in research has been ensured.

Conflict of Interest

The Authors declare that there is no conflict of interest.

Disclosure

Giuseppe Biondi-Zoccai has consulted, lectured and/or served as advisory board member for Abiomed, Advanced Nanotherapies, Aleph, Amarin, AstraZeneca, Balmed, Cardionovum, Cepton, Crannmedical, Endocore Lab, Eukon, Guidotti, Innovheart, Meditrial, Menarini, Microport, Opsens Medical, Synthesa, Terumo, and Translumina, outside the present work. All other authors report no conflict of interest.

References

  1. Reynolds DW, Ritter P. A leadless intracardiac transcatheter pacing System NEngl J Med. 2016;374:2604- 2605.
  2. El-Chami MF, Al-Samadi F, Clementy N, et al. Updated performance of the Micra transcatheter pacemaker in the real-world setting: A comparison to the investigational study and a transvenous historical control. Heart Rhythm. 2018;15:1800-1807.
  3. Duray GZ, Ritter P, El-Chami M, et al. Long-term performance of a transcatheter pacing system: 12 month results from the Micra transcatheter pacing study, Heart Rhythm. 2017;14:702-709.
  4. El-Chami MF, Johansen JB, Zaidi A, et al. Leadless pacemaker implant in patients with pre-existing infections: Results from the Micra postapproval registry. J Cardiovasc Electrophysiol. 2019;30:569- 574.
  5. Li J, Hou W, Cao M, et al. Safety and efficacy of leadless pacemaker retrieval. J Cardiovasc Electrophysiol 2019;30:1671–1678.
  6. Terricabras M, Khaykin Y. Successful leadless pacemaker retrieval from the left pulmonary artery: A case report. HeartRhythm Case Rep. 2020 Aug 17;6(10):798-799. doi: 10.1016/j.hrcr.2020.08.004. eCollection 2020 Oct.
  7. Romeo E, D'Alto M, Cappelli M, Nigro G, Correra A, Colonna D, Sarubbi B, Golino P. Retrieval of a leadless transcatheter pacemaker from the right pulmonary artery: A case report. Pacing Clin Electrophysiol. 2021 May;44(5):952-954. doi: 10.1111/pace.14135. Epub 2021 Feb 16.
  8. Sterlinski M, Demkow M, Plaskota K, Oreziak A. Percutaneous extraction of a leadless Micra pacemaker from the pulmonary artery in a patient with complex congenital heart disease and complete heart block. EuroIntervention. 2018;14(2):236–237.
  9. Afzal MR, Jamal SM, Son JH, Chung JH, Gabriels J, Okabe T, Hummel JD, Augostini RS. Tips and Tricks for Safe Retrieval of Tine-based Leadless Pacemakers. J Innov Card Rhythm Manag. 2021 Jun 15;12(6):4562-4568. doi: 10.19102/icrm.2021.120606.
  10. Afzal MR, Daoud EG, Cunnane R, et al. Techniques for successful early retrieval of the Micra transcatheter pacing system: a worldwide experience. Heart Rhythm. 2018;15(6):841–846. doi: 10.1016/j.hrthm.2018.02.008.
  11. Beurskens NE, Tjong FV, Knops RE. End-of-life Management of Leadless Cardiac Pacemaker Therapy. Arrhythm Electrophysiol Rev. 2017 Aug;6(3):129-133. doi: 10.15420/aer.2017:16:1.
Retrieved from ‘https://journal.topitalianscientists.org/index.php?title=Leadless_pacemaker_retrieval_from_the_left_pulmonary_artery_in_a_patient_with_left_persistent_vena_cava_a_case_report&oldid=2405’