Extraction of Micra Leadless Pacemaker and Upgrade to Left Bundle Branch Pacing: A Case Report

Pacing-induced cardiomyopathy (PICM) is an important cause of the left ventricular systolic disfuction in patients with chronic high-burden right ventricular pacing. Recent evidence suggests that an upgrade to Left bundle branch pacing (LBBP) may confer benefit in PICM. Leadless pacemakers (LPs), represented by the Micra AV device, are widely applied in the treatment of bradyarrhythmias due to their minimal trauma and low complication rates. However, high burden right ventricular pacing (RVP) from Micra AV implantion may still induce PICM, and there is a lack of mature experience in the extraction of Micra AV devices combined with LBBP upgrade. The case report aims to introduce a feasible strategy for Micra AV extraction and subsequent LBBP upgrade in patients with PICM. The dual-snare technique is a safe and effective method for minimally invasive extraction of Micra AV leadless pacemakers.