Pak Misun, Kakita Ken, Yamasaki Takashi, Hattori Tetsuhisa
Arrhythmia Care Center, Koseikai Takeda Hospital, Kyoto, Japan.
Case Rep Cardiol. 2025 May 9;2025:4729674. doi: 10.1155/cric/4729674. eCollection 2025.
A 78-year-old man underwent Micra AV implantation due to complete atrioventricular block. He developed diffuse left ventricular systolic dysfunction and dyssynchrony, 2 years later, suggesting pacing-induced cardiomyopathy. Given the critical need for an upgrade to cardiac resynchronization therapy (CRT), an extraction of the Micra AV was scheduled. Initially, the Micra extraction using a solitary snare catheter was attempted, but capturing the retrieval feature on the proximal side of the device was unsuccessful due to excessive movement caused by the heartbeats. Consequently, an axis-guided dual snare technique employing two snare catheters was implemented. A triple-loop snare catheter was inserted into a steerable sheath, which was threaded through the loop of a single-loop snare catheter placed outside the sheath. The triple-loop snare successfully grasped the Micra body and stabilized its movement. Subsequently, the single-loop snare was advanced along the shaft of the triple-loop snare catheter towards the retrieval feature. The single-loop snare finally captured the retrieval feature, enabling the smooth retraction of the Micra into the sheath. Following the successful extraction of the Micra, a CRT device was implanted without complications.
一名78岁男性因完全性房室传导阻滞接受了Micra AV植入术。两年后，他出现了弥漫性左心室收缩功能障碍和不同步，提示起搏诱导性心肌病。鉴于迫切需要升级为心脏再同步治疗（CRT），计划取出Micra AV。最初，尝试使用单圈套器导管取出Micra，但由于心跳引起的过度移动，未能在设备近端捕获取回特征。因此，采用了使用两个圈套器导管的轴引导双圈套技术。将一个三圈套器导管插入可操纵鞘管中，该鞘管穿过置于鞘管外的单圈套器导管的环。三圈套器成功抓住了Micra主体并稳定了其移动。随后，单圈套器沿着三圈套器导管的轴向前推进至取回特征处。单圈套器最终捕获了取回特征，从而能够将Micra顺利收回鞘管。成功取出Micra后，植入了CRT设备，未出现并发症。
