Leadless pacemaker retrieval from the left pulmonary artery in a patient with left persistent vena cava: a case report

Leadless pacemakers (LPMs) represent an important advancement in cardiac pacing, particularly for patients with venous access limitations or a history of device-related complications. Although implantation techniques are standardized, percutaneous retrieval of LPMs remains a challenging and rarely performed procedure. We present the case of an 85-year-old male with persistent left superior vena cava (PLSVC) and multiple prior pacemaker interventions, who presented with leadless pacemaker dislodgement into a peripheral branch of the left pulmonary artery. The device was successfully retrieved percutaneously using a transfemoral approach involving two different-sized snares and a deflectable catheter system, overcoming significant technical challenges and secondary migration into the dilated coronary sinus. This case underscores the considerable procedural issues of LPM retrieval in complex anatomical settings and highlights the importance of tailored interventional strategies to ensure safe device extraction.