Korean Circ J.  2011 Mar;41(3):164-166. 10.4070/kcj.2011.41.3.164.

Implantable Cardioverter-Defibrillator Lead Extraction by Conventional Traction and Counter-Traction Technique

• Park JS
• Pak HN
• Lee MH
• Kim SS
• Joung B

• KMID: 2225133
• DOI: http://doi.org/10.4070/kcj.2011.41.3.164

Abstract

A 46-year-old man presented to our institution with inappropriate implantable cardioverter-defibrillator (ICD) shock delivery. The ICD (single chamber, dual shock coils) was implanted for sustained monomorphic ventricular tachycardia with unstable hemodynamics and underlying systolic left ventricular dysfunction. ICD interrogation revealed recurrent episodes of ICD shock due to noise sensing and increased impedance of right ventricular-lead. With the impression of lead fracture, ICD lead extraction was performed. The fractured ICD lead was completely removed by traction of locking stylet and counter-traction of polypropylene dilator sheath. A new lead was inserted and the patient was discharged without complications after 2 days. To our knowledge, this is the first report on ICD lead extraction by conventional traction and counter-traction technique in Korea.

Keyword

Implantable cardioverter defibrillators; Medical device failure; Device removal

MeSH Terms

Defibrillators, Implantable
Device Removal
Electric Impedance
Equipment Failure
Hemodynamics
Humans
Korea
Middle Aged
Noise
Polypropylenes
Shock
Tachycardia, Ventricular
Traction
Ventricular Dysfunction, Left
Polypropylenes

Figure

• 

  Fig. 1 Intracardiac ventricular electrogram shows fast and irregularly irregular ventricular activities (VS) unmatched by normal ventricular activities (regular QRS complexes on surface electrocardiography). A: noise sensing caused by lead fracture was interpreted as ventricular fibrillation by ICD. B: impedance of ICD lead increased abruptly from baseline 650 ohms to >2,500 ohms within 3 weeks, suggestive of lead fracture. ICD: implantable cardioverter-defibrillator, V-EGM: ventricular electrogram, Marker: marker channel.

• 

  Fig. 2 The fractured ICD lead (tined type, diameter: 2.7 mm) was completely removed by traction and counter-traction technique using locking stylet and a 12 Fr (diameter: 4 mm) polypropylene dilator sheath. ICD: implantable cardioverter-defibrillator.

Reference

1. Kim DH, Kim SY, Lee KH, et al. Follow-up of a group of patients with automatic implantable defibrillator. Korean Circ J. 2005. 35:69–83.

2. Kim YH, Kim JS. Clinical characteristics in patients with implantable cardioverter-defibrillator (ICD). Korean Circ J. 2004. 34:395–404.

3. Smith HJ, Fearnot NE, Byrd CL, Wilkoff BL, Love CJ, Sellers TD. Five-years experience with intravascular lead extraction. U.S. Lead Extraction Database. Pacing Clin Electrophysiol. 1994. 17:2016–2020.

4. Byrd CL, Wilkoff BL, Love CJ, et al. Intravascular extraction of problematic or infected permanent pacemaker leads: 1994-1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol. 1999. 22:1348–1357.

5. Becker AE, Becker MJ, Claudon DG, Edwards JE. Surface thrombosis and fibrous encapsulation of intravenous pacemaker catheter electrode. Circulation. 1972. 46:409–412.

6. Hauser RG, Katsiyiannis WT, Gornick CC, Almquist AK, Kallinen LM. Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction. Europace. 2010. 12:395–401.

7. Molina JE. Undertreatment and overtreatment of patients with infected antiarrhythmic implantable devices. Ann Thorac Surg. 1997. 63:504–509.

8. Eckart RE, Hruczkowski TW, Landzberg MJ, Ames A, Epstein LM. Pulmonary arterial embolization of pacemaker lead electrode tip. Pacing Clin Electrophysiol. 2006. 29:784–787.

9. Böhm A, Bányai F, Komáromy K, Pintér A, Préda I. Cerebral embolism due to a retained pacemaker lead: a case report. Pacing Clin Electrophysiol. 1998. 21:629–630.

10. Rosenheck S, Weiss A, Leibowitz D, Sharon Z. Noninstrumental pacemaker and defibrillator lead removal: the importance of the rotation forces. Pacing Clin Electrophysiol. 2002. 25:1029–1036.

11. Alt E, Neuzner J, Binner L, et al. Three-year experience with a stylet for lead extraction: a multicenter study. Pacing Clin Electrophysiol. 1996. 19:18–25.

12. Klug D, Jarwé M, Messaoudéne SA, et al. Pacemaker lead extraction with the needle's eye snare for countertraction via a femoral approach. Pacing Clin Electrophysiol. 2002. 25:1023–1028.

13. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Reiser C. Clinical study of the laser sheath for lead extraction: the total experience in the United States. Pacing Clin Electrophysiol. 2002. 25:804–808.

14. Neuzil P, Taborsky M, Rezek Z, et al. Pacemaker and ICD lead extraction with electrosurgical dissection sheaths and standard transvenous extraction systems: results of a randomized trial. Europace. 2007. 9:98–104.