Double-snare technique for helix-fixation leadless cardiac pacemaker retrieval

When implanting leadless pacemakers (LP), it is essential to understand retrieval techniques in case the device dislodges or requires acute revision. Various methods for acute retrieval such as reverse-orientation retrieval and using a superior approach from the internal jugular vein have been described previously in detail. 1 Ip J.E. Conventional and Novel Methods for Early Retrieval a Helix-Fixation Leadless Cardiac Pacemaker. JACC Clin Electrophysiol. 2023; 9: 2392-2400 Google Scholar If the LP is free-floating, a retrieval catheter can capture the device. However, if the LP is snared along the body, the device cannot easily be brought back into the introducer sheath for removal. In such a scenario, the “threading-a-needle” technique (sequentially rotating and retracting the retrieval catheter to guide the snared end of the LP into the introducer sheath) can avoid needing to release and recapture the LP. 1 Ip J.E. Conventional and Novel Methods for Early Retrieval a Helix-Fixation Leadless Cardiac Pacemaker. JACC Clin Electrophysiol. 2023; 9: 2392-2400 Google Scholar Because the atrial LP is shorter than the ventricular LP (32.2 mm vs 38.0 mm), an alternative method might be needed that involves using a second snare that has been used to capture free-floating Medtronic Micra LPs (26.0 mm). 2 Goyal R. Markowitz S.M. Ip J.E. Double-Snare Technique for Capturing a Wandering Leadless Pacemaker. JACC Clin Electrophysiol. 2019; 5: 872-873 Google Scholar