Protection of Atrial Electrode Wire in Extracting VDD Lead

概要

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Backgrounds: Laser lead extraction system has been introduced and the complete removal of the pacing system can be achieved transvenously in many cases. However, there are various pitfalls during the procedure. Case Report: A 87-year-old male was referred for us for the lead extraction due to recurent pocket infection. The VDD pacing lead was implanted via left subclavian vein against atrio-ventricular block in 1993. Atrial lead was added on the same side for the better atrial sensing in 2002. The pacemaker itself had been already removed and both leads were cut short. We tried lead extraction under general anesthesia in 2011. We put the locking stylets into both leads and used laser sheath. Atrial lead came out smoothly. However, VDD lead was severely adhered to the supra vena cava especially at the point of atrial sensing electrodes. During the procedure, insulation of the VDD lead was damaged and atrial electrode wire was exposed outside the lead and we could not advance the laser sheath. To salvage the atrial wire, we caught the wire tied with strings and pulled back. Finally, we could remove the pacing system transvenously. Conclusion: In the lead extraction of aged VDD lead, atrial electrode wire can be exposed. Protection of the atrial wire should be considered.