When the Kite Flies Away
Dr. Tsz-Kin TAM
Prince of Wales Hospital, Hong Kong
A 83-year-old lady with history of hypertension and hyperlipidemia suffered from symptomatic 2 to 1 atrioventricular (AV) block. In view of advanced age and limited mobility, she opted for leadless pacemaker. She has a small body built (BSA: 1.52m2).
The first two deployment resulted in unsatisfactory parameters with recapture of device performed uneventfully. Third deployment was at apex again, but again resulted in poor pacing threshold (Movie 1). Recapture was difficult owing to the unfavorable acute angle between the recapture cone and the Micra. After prolonged manipulation, the Micra was dislodged from the myocardial anchorage. While the operator attempted to realign the dislodged Micra by gently pulling the tether, the tether was found broken. As a result, the Micra was embolized to the inferior branch of left pulmonary artery (Movie 2).
Percutaneous snaring of the device was attempted. The upside-down position of the embolized Micra meant that the snare was only be able to reach the tines (Movie 3). With two snaring devices (Movie 4, Movie 5, Movie 6), the device (Movie 7) was successfully removed via the Micra delivery sheath.