A Case of Successful Extraction of a Micra Leadless Pacemaker Implanted Two Years Prior Using the Axis-Guided Dual Snare Technique.

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.