ArticleJACC. Case reports2026
Double-Snare Retrieval and Mapping-Guided Reimplantation of a Dislodged Atrial Leadless Pacemaker.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAtrial leadless pacemaker (LP) dislodgement is an uncommon but serious complication, more frequent than ventricular LP dislodgement. CASE SUMMARY: A 64-year-old man with tachycardia-bradycardia syndrome and end-stage renal disease on long-term hemodialysis underwent a dual-chamber LP implantation. The atrial LP initially demonstrated acceptable electrical parameters, but the capture threshold progressively increased, leading to early battery depletion; repeat implantation again showed high thresholds (4.25 V at 0.4 ms). One week later, imaging revealed atrial LP dislodgement with inversion into the right ventricle. Fixation helix capture was unreliable, and device slippage occurred during withdrawal. A double-snare technique stabilized the LP, enabling secure docking and extraction. Given suspected uremic atrial myopathy, 3-dimensional electroanatomic mapping guided reimplantation, achieving excellent electrical performance. DISCUSSION: Double-snare retrieval improves procedural control during complex retrievals, while mapping-guided implantation may reduce fixation failure in diseased atria. TAKE-HOME MESSAGES: Double-snare retrieval enhances safety in inverted atrial LP dislodgement. Preimplant 3-dimensional mapping optimizes atrial LP outcomes.
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