When to stop pulling during percutaneous lead extraction: Role of collaborative multidisciplinary team approach
Singh G, Lahiri MK, Khan A, Maskoun W, Schuger CD. When to stop pulling during percutaneous lead extraction: Role of collaborative multidisciplinary team approach. J Interv Card Electrophysiol. 2018;51(1):S81-S82.
J Interv Card Electrophysiol
Background: Pacemaker and ICD leads are usually extracted safely with percutaneous approaches using mechanical and laser tools. Open surgical extraction is usually not required to high success rates of percutaneous approach. Objectives: To highlight risks and limitations ofpercutaneous lead extraction methods and need for converting the procedure to an open surgical extractionMethods: N/A Results: A 65-year-old female with hypertension, diabetes mellitus, and ischemic cardiomyopathy was transferred for ICD lead extraction due to persistent MSSA bacteremia after failing intravenous antibiotics course. TEE revealed vegetations on 20-year-old dual coil defibrillator lead in the SVC region and tricuspid valve region (Fig. A). Binding sites were lased with a 16 Fr Spectranetics ® sheath until significant resistance was noted at the level of low right atrium and tricuspid valve. Patient became hypotensive and developed ventricular arrhythmia requiring external defibrillation duringattempts to advance the laser and mechanical sheaths when intra-procedural TEE showed obliteration of RV inflow due to lead adhesion at the tricuspid valve level (Fig. B). Further percutaneous attempts were abandoned due to risk of perforation and severe valve damage and patient underwent successful open surgical extraction (Fig. C). Conclusion: This case highlights presence of significant adhesions with long dwelling ICD leads at the level oftricuspid valve and low right atrium thus limiting safe removal using percutaneous techniques and importance ofintraprocedural TEE with timely switch to open surgical procedure in a non-emergent fashion.