Lead Removal of Cardiac Implantable Electronic Device

Abstract

As more people are living longer with more significant cardiac disease,
permanent pacemakers (PPMs) and implantable cardioverter-defibrillators
(ICDs) are being inserted more frequently each year. Beginning early in the
21st century, there has also been an expansion in the indications for cardiac
implantable electronic devices (CIED, a term which includes PPMs and
ICDs), and device therapy has become more complex, frequently involving
multiple leads per patient. In turn, there will be more occasion where the
lead removal for these CIED will be necessary.
A 6 y.o. patient was incidentally found to have a fractured pacemaker lead
during during routine x-ray for his respiratory tract infection. The pacemaker
was inserted 5 years ago, indicated for the permanent total atrioventricular
block developed after total correction surgery in Tetralogy of Fallot. The
lead fracture was thought to be caused by a phenomenon known as the
subclavian crush syndrome. A transvenous lead extraction in this patient
was only partially successful, leading to a surgical removal of the remaining
lead. A new permanent pacemaker along with a new lead in the apex
was successfully inserted before the surgery.
There are different levels of recommendations on whether a lead should
be extracted or left behind. And in times where removal was needed,
new specialized tool and techniques have developed in the last decade for
the safe and successful retrieval of implanted pacemaker leads.