Transvenous extraction of double dual-coil implantable cardioverter-defibrillator leads – Case report

<p>Abstract: Implantable cardioverter-defibrillator (ICD) is the standard treatment for prevention of sudden cardiac death (SCD) in high-risk patients. Transvenous lead extraction (TLE) is an integral part of management of patients with ICD, since ICD leads are prone to damage in long-term follow-up. TLE is a procedure with high risk of complications. Major complications include haemothorax , thromboembolic events, vascular laceration, cardiac avulsion, and even death, with pericardial tamponade beeing the most common major complication. We report the clinical case of a 54-year-old male patient with a history of chronically implanted ICD who presented with isolated pocket erosion. Cardiac fluoroscopy revealed one dual-coil ICD lead connected to the pulse generator and another dual-coil ICD lead was noted to be fractured, with the proximal end lead remnant in the ICD pocket. Suspicion of pocket infection was raised, therefore the device and the leads extractions were necessary. Dual-coil implantable cardioverter-defibrillator leads are difficult to extract due to fibrotic scar tissue formed around the leads especially near the coils. Transvenous lead extraction technique was used to remove the dual-coil implantable cardioverter-defibrillator leads, without neither major nor minor complications. As ICD therapy was recommended for secondary prophylaxis, a new ICD was implanted on the contralateral side.</p>