Treating an infected transcatheter pacemaker system via percutaneous extraction

Introduction One of the most feared complications of a traditional pacemaker system is cardiac implantable electronic device infection. In such cases, a complete removal of the entire system is recommended. With the advent of the leadless transcatheter pacemaker system (TPS), the weak link— namely, the pacing leads that contribute to this problem— can be ultimately eliminated. At least 2 major studies have shown negligible infection rate with the leadless TPS. Nevertheless, this does not discount the possibility of an infection ever affecting a TPS. Should that happen, whether an extraction is warranted is yet to be recommended. Some studies on sheep have demonstrated the possibility of safely extracting the TPS percutaneously. The first-inhuman extraction of a Micra TPS 3 weeks after implantation owing to elevated capture threshold was recently reported by Karim et al. In this report, we describe the world’s first infected Micra TPS, which eventually led to its extraction percutaneously 1 month after implantation.