Fichtner Stephanie, Estner Heidi L, Näbauer Michael, Hausleiter Jörg
Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich, Marchioninistr. 15, Munich, Germany.
German Cardiovascular Research Centre (DZHK), Partner Site, Munich Heart Alliance, Biedersteiner Str. 29, Munich, Germany.
Eur Heart J Case Rep. 2019 Jul 13;3(3). doi: 10.1093/ehjcr/ytz113.
Leadless pacemaker implantation rates are increasing worldwide. Until now leadless pacemaker dislocation and extraction has been rarely reported.
An 83-year-old patient with cardiac amyloidosis, chronic atrial fibrillation, and complete heart block was implanted with a leadless pacemaker (Micra, Medtronic). On the day after implantation, the device showed an exit block and on cardiac echocardiography and cardiac computer tomography, a device dislocation could be detected. During the day, the device moved at least three times between the tricuspid valve and the right ventricular apex. Each time causing non-sustained ventricular tachycardia. At the next day device extraction was scheduled. After 189 minutes of procedure time, it was possible to retrieve the device with the help of two steerable introducers (Agilis) and two snare catheters.
Implantable transcatheter leadless pacemakers can be implanted safely most of the time. However, in rare cases device dislocations may occur. Device extraction is possible, but is described as challenging in most published cases 10.1093/ehjcr/ytz113_audio1 ytz113_audio1 6074457264001.
无导线起搏器的植入率在全球范围内不断上升。到目前为止，无导线起搏器脱位和取出的情况鲜有报道。
一名83岁患有心脏淀粉样变性、慢性心房颤动和完全性心脏传导阻滞的患者植入了无导线起搏器（美敦力公司的Micra）。植入后的第二天，该装置显示出出口阻滞，心脏超声心动图和心脏计算机断层扫描显示存在装置脱位。在当天，该装置在三尖瓣和右心室尖之间至少移动了三次，每次都引发了非持续性室性心动过速。第二天安排了装置取出手术。经过189分钟的手术时间，借助两个可操纵的导入器（Agilis）和两个圈套导管成功取出了该装置。
大多数情况下，可植入式经导管无导线起搏器能够安全植入。然而，在极少数情况下可能会发生装置脱位。装置取出是可行的，但在大多数已发表的病例中被描述为具有挑战性。
