Retrieval of Medtronic Micra Transcatheter Pacing System after tether removal.

We implanted a Medtronic Micra Transcatheter Pacing System (TPS) using standard technique, but after cutting the tether, a slight resistance was felt when the tether was pulled back. Subsequently, the electrical properties of the system were unacceptable. In order to retrieve the TPS, a 3 F snare with a 10–25 mm loop can be loaded into the delivery system. However, this snare was not available. Instead, the delivery system was retracted, and the introducer was left in the patient. A standard steerable sheath (Agilis, St Jude Medical) was introduced into the introducer, but there was a significant blood leak from the introducer’s haemostatic valve due to the incongruent sizes. Introducing a short 14 F sheath between the introducer and the steerable sheath solved this problem. A standard 6 F 20 mm snare kit (Amplatz Goose Neck) subsequently was used to grab the TPS (Figure), which could be released from the myocardium with a gentle pull and retrieved back into the introducer sheath. Echocardiography excluded pericardial effusion, and a new Micra TPS was implanted uneventfully. It is recommended to have a correctly dimensioned snare in stock during TPS implantation. In case, for some reason, TPS retrieval is not possible using a small snare, this report describes an alternative strategy.