Ando Yu, Morishita Tetsuji, Yajima Takahiro, Kojima Yoshinobu, Kondo Hiroki, Ueno Katsumi, Morita Norihiko
Department of Cardiovascular Medicine, Matsunami General Hospital, Gifu, Japan.
Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan.
Eur J Case Rep Intern Med. 2025 May 20;12(6):005488. doi: 10.12890/2025_005488. eCollection 2025.
Leadless pacemakers have been widely adopted for their safety and efficacy in treating bradyarrhythmia. While rare, device dislodgement during implantation necessitates retrieval.
We present the case of a 91-year-old man with end-stage renal failure receiving maintenance dialysis, who experienced symptomatic complete atrioventricular block. During leadless pacemaker implantation, after multiple unsuccessful attempts to secure the device in the right ventricle, the device dislodged into the right atrium during tether traction. The device initially caught on the tricuspid valve before floating into the posterior right atrium near the inferior vena cava. Using a snare technique, we successfully retrieved the device within 115 minutes of dislodgement. Post-procedure imaging showed no complications. This case highlights that unexpected migration into the right atrium may facilitate safer, simpler retrieval compared to right ventricular or pulmonary artery dislodgement.
The right atrial location offered advantages including reduced cardiac motion influence and fewer premature contractions, enabling easier capture from the inferior vena cava using the snare. Prompt recognition and management of device dislodgement during implantation procedures is of key importance.
This report highlights the successful retrieval of a leadless pacemaker that migrated into the right atrium during implantation.Clinicians will learn the importance of prompt recognition of device displacement and how unexpected migration to the right atrium can facilitate safer retrieval, particularly using a snare.Understanding the implications of device migration into the right atrium versus more complex locations, such as the right ventricle or pulmonary artery, is essential for effective management of leadless pacemaker implantation complications.
无导线起搏器因其在治疗缓慢性心律失常方面的安全性和有效性而被广泛采用。虽然罕见，但植入过程中设备移位需要取出。
我们报告一例91岁终末期肾衰竭接受维持性透析的男性患者，其出现有症状的完全性房室传导阻滞。在无导线起搏器植入过程中，多次尝试将设备固定在右心室均未成功，在牵拉系绳时设备移位至右心房。该设备最初卡在三尖瓣上，随后漂浮至下腔静脉附近的右心房后部。我们采用圈套技术，在设备移位后115分钟内成功将其取出。术后影像学检查未发现并发症。该病例表明，与移位至右心室或肺动脉相比，意外移位至右心房可能有助于更安全、更简单地取出设备。
右心房位置具有优势，包括减少心脏运动影响和减少早搏，便于使用圈套器从下腔静脉更容易地捕获。在植入过程中及时识别和处理设备移位至关重要。
本报告强调了在植入过程中移位至右心房的无导线起搏器的成功取出。临床医生将了解及时识别设备移位的重要性，以及意外移位至右心房如何有助于更安全地取出，特别是使用圈套器。了解设备移位至右心房与更复杂位置（如右心室或肺动脉）的影响，对于有效管理无导线起搏器植入并发症至关重要。
