Czulada Evan, Kabadi Rajiv, Basyal Binaya, Hadadi Cyrus, Thomaides Athanasios
Georgetown University School of Medicine, Washington, DC, USA.
Department of Electrophysiology, MedStar Health: Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, DC, USA.
J Innov Card Rhythm Manag. 2024 Dec 15;15(12):6126-6129. doi: 10.19102/icrm.2024.15126. eCollection 2024 Dec.
Leadless pacemakers (LPs) are emerging options for bradyarrhythmias. However, extraction can be risky if the device is in an unfavorable position. We present a challenging case of a Nanostim LP (NLP) (Abbott Medical Inc., Abbott Park, IL, USA) placed 8 years prior to removal and subsequent replacement with an AVEIR LP (ALP) (Abbott). A 72-year-old man received an NLP in 2015 for persistent atrial fibrillation with bradycardia. The NLP could not be interrogated in our office. An external event monitor demonstrated persistent atrial fibrillation with bradycardia and pauses. A premature battery depletion of the NLP was suspected. An ALP was chosen for replacement. On a computed tomography scan of the chest, the NLP was seen in the mid-free wall of the right ventricle, and its proximal portion abutted the tricuspid annulus. The AVEIR retrieval catheter (ARC) was used for retrieval. Multiple attempts were made to snare the device, yet it proved difficult due to poor placement and button tissue formation. The snare became damaged, and a second ARC was needed. On the successful attempt, the NLP was snared proximally and permitted docking. We advanced the protective sleeve over the NLP body, but resistance was observed due to tissue growth. Counterclockwise torsion was applied, and the device disconnected. Once the NLP was in linear orientation, the protective sleeve was eventually positioned over its body, allowing removal. The ALP was then installed without difficulty or structural complications. This report shows the importance of proper LP placement in the right ventricular septal wall. LP removal can be performed safely, yet complications can arise based on the age and location of the LP. The ARC can be successfully used to extract non-AVEIR LPs with evidence of docking button tissue growth. Similar interventions should exercise caution when attempting extraction and subsequent implantation.
无导线起搏器（LPs）正成为治疗缓慢性心律失常的新选择。然而，如果该装置位置不佳，取出可能存在风险。我们报告一例具有挑战性的病例，患者8年前植入了Nanostim无导线起搏器（NLP）（美国伊利诺伊州雅培公园市雅培医疗公司），此次需取出并随后更换为AVEIR无导线起搏器（ALP）（雅培公司）。一名72岁男性在2015年因持续性房颤伴心动过缓接受了NLP植入。在我们办公室无法对NLP进行问询。外部事件监测仪显示持续性房颤伴心动过缓和停搏。怀疑NLP电池过早耗尽。选择ALP进行更换。胸部计算机断层扫描显示，NLP位于右心室游离壁中部，其近端部分紧邻三尖瓣环。使用AVEIR取出导管（ARC）进行取出操作。多次尝试圈套该装置，但由于位置不佳和纽扣组织形成，操作困难。圈套器受损，需要第二个ARC。成功的那次尝试中，在近端圈套住NLP并使其对接。我们将保护套套在NLP主体上，但由于组织生长观察到有阻力。施加逆时针扭转，装置断开。一旦NLP呈直线方向，保护套最终套在其主体上，从而实现取出。随后顺利植入ALP，未出现结构并发症。本报告显示了将LPs正确植入右心室间隔壁的重要性。LPs取出可以安全进行，但根据LPs的使用时长和位置可能会出现并发症。ARC可以成功用于取出有纽扣组织生长证据的非AVEIR无导线起搏器。类似的干预措施在尝试取出和随后植入时应谨慎操作。
