A case of thoracoscopy-guided lead extraction with an excimer laser sheath

概要

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The patient was a 29-year-old male who had been diagnosed with transposition of the great arteries with an intact ventricular septum. At the age of 6 months, he underwent a Senning operation. At the age of 10 years, a dual-chamber (DDD) pacemaker was implanted via the right subclavian vein for the treatment of sick sinus syndrome. At the age of 25, the generator was removed due to a lead fracture, and a new pacemaker was implanted via the left subclavian vein, leaving the previous lead in the right subclavian vein. Later, the patient developed pain in the right precordium, cramping of the major pectoral muscle, and non-sustained ventricular tachycardia, suggesting physical stimulation of the left ventricle (functional right ventricle) by the residual leads. Therefore, lead extraction using an excimer laser sheath was planned. However, the leads adhered strongly to the vessels, and extraction was considered to involve a high risk of injury to the blood vessels, particularly the superior vena cava (SVC). We inserted a thoracoscope via the right precordial third intercostal space and observed the SVC via the thoracic cavity in order to immediately detect any complications. Using this approach, it was possible to extract the lead safely with an excimer laser sheath.