Conservative management of a dislodged leadless pacemaker wedged in the pulmonary artery assessed by pulmonary perfusion scintigraphy: a case report.
- 1The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
Abstract
Background
Leadless pacemakers reduce complications associated with conventional transvenous systems; however, device dislodgement with pulmonary artery embolization is a rare complication unique to leadless pacemakers. Although prompt retrieval is generally recommended, retrieval from the pulmonary artery may carry procedural risks, particularly in elderly or high-risk patients.Case summary
An 84-year-old woman with complete atrioventricular block underwent implantation of a leadless pacemaker. Although the pacing threshold was favourable, the R-wave amplitude was low, and unstable device movement was observed after tether release, suggesting inadequate fixation. Two hours after implantation, pacing failure occurred, and chest radiography showed migration of the device into the right pulmonary artery. The following day, the device migrated to the left posterior basal segmental pulmonary artery and remained stably wedged. Because of the risk associated with retrieval, conservative management was selected, and a transvenous pacemaker was implanted. Serial lung perfusion scintigraphy demonstrated right-to-left perfusion distributions of 60.5% vs. 39.5% at 10 days, 59.1% vs. 40.9% at 3 months, and 58.5% vs. 41.5% at 1 year, without progressive deterioration in left lung volume. The patient remained asymptomatic over 3 years of follow-up.Discussion
This case illustrates that conservative management may be feasible in carefully selected high-risk patients when an embolized leadless pacemaker is stably wedged within the pulmonary artery. Serial pulmonary perfusion scintigraphy may provide objective evidence of preserved pulmonary perfusion and support long-term follow-up after conservative management.
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BibTeX
@article{arimoto2026conservative,
title = {{Conservative management of a dislodged leadless pacemaker wedged in the pulmonary artery assessed by pulmonary perfusion scintigraphy: a case report.}},
author = {Takanori Arimoto and Daisuke Kutsuzawa and Naoaki Hashimoto and Ken Watanabe and Masafumi Watanabe},
journal = {European heart journal. Case reports},
year = {2026},
month = oct,
doi = {10.1093/ehjcr/ytag749},
url = {https://europepmc.org/article/MED/42921479},
note = {CC BY},
}
RIS
TY - JOUR
TI - Conservative management of a dislodged leadless pacemaker wedged in the pulmonary artery assessed by pulmonary perfusion scintigraphy: a case report.
AU - Takanori Arimoto
AU - Daisuke Kutsuzawa
AU - Naoaki Hashimoto
AU - Ken Watanabe
AU - Masafumi Watanabe
PY - 2026
DA - 2026/10/16
JO - European heart journal. Case reports
DO - 10.1093/ehjcr/ytag749
UR - https://europepmc.org/article/MED/42921479
AB - Background Leadless pacemakers reduce complications associated with conventional transvenous systems; however, device dislodgement with pulmonary artery embolization is a rare complication unique to leadless pacemakers. Although prompt retrieval is generally recommended, retrieval from the pulmonary artery may carry procedural risks, particularly in elderly or high-risk patients.Case summary An 84-year-old woman with complete atrioventricular block underwent implantation of a leadless pacemaker. Although the pacing threshold was favourable, the R-wave amplitude was low, and unstable device movement was observed after tether release, suggesting inadequate fixation. Two hours after implantation, pacing failure occurred, and chest radiography showed migration of the device into the right pulmonary artery. The following day, the device migrated to the left posterior basal segmental pulmonary artery and remained stably wedged. Because of the risk associated with retrieval, conservative management was selected, and a transvenous pacemaker was implanted. Serial lung perfusion scintigraphy demonstrated right-to-left perfusion distributions of 60.5% vs. 39.5% at 10 days, 59.1% vs. 40.9% at 3 months, and 58.5% vs. 41.5% at 1 year, without progressive deterioration in left lung volume. The patient remained asymptomatic over 3 years of follow-up.Discussion This case illustrates that conservative management may be feasible in carefully selected high-risk patients when an embolized leadless pacemaker is stably wedged within the pulmonary artery. Serial pulmonary perfusion scintigraphy may provide objective evidence of preserved pulmonary perfusion and support long-term follow-up after conservative management.
SN - 2514-2119
ER -