Removal of tine-based leadless pacemakers: insights from a large multicentre experience

Aims: As implantation rates of leadless pacemakers (LPM) increase, a growing number of patients will require assessment of LPM removability. This multicentre study investigated the safety and feasibility of removal of tine-based LPMs. Methods and results: We retrospectively analysed consecutive patients who underwent tine-based LPM removal between March 2016 and January 2024 across 11 centres in Europe and the USA. Demographic characteristics, indication for LPM removal, procedural success, and complication rates were assessed. A total of 85 patients [median age 73 years (IQR 64-82)] were included. Indications for LPM removal included temporary use after transvenous lead extraction (23.5%), upgrade to a biventricular pacing system (22.4%) or a transvenous dual-chamber pacemaker (9.4%), and increased pacing thresholds (21.2%). The median device dwell time was 96 days (IQR 29-320 days), and the overall procedural success rate was 96.5%. In the majority of cases, removal was performed using a steerable sheath in combination with a single-loop snare. Procedure-related adverse events occurred in 5.9% of patients, including two pericardial effusions and three cases of device embolization. Significant predictors of removal failure (n = 3, 3.5%) were apical device position [odds ratio (OR) 61.8.0; 95% confidence interval (CI) 2.5-788716.3, P = 0.008] and longer device dwell time [OR 1.4; 95% CI 1.1-2.4, P = 0.008]. Conclusion: Removal of tine-based LPMs, typically after short- to mid-term device dwell times, was generally feasible and safe.