Endovascular extraction techniques: Part 3: Results and indications in patients with an ICD.

INTRODUCTION

We report our experience with lead extraction in patients with an implantable cardioverter defibrillator (ICD) and discuss the indications for extraction in these patients.

PATIENTS

Eighteen patients with an ICD (mean age 58±12 years) were referred for lead extraction: two patients with infection and 16 with lead dysfunction.

METHODS

Lead extraction was performed with a laser sheath (Excimer) if traction with a locking device was insufficient. New leads were implanted during the same procedure, if applicable.

RESULTS

Shock leads were successfully extracted in 16 patients and additional pace-sense leads in seven patients. In two patients, the shock conductor was considered unaffected and only a pace-sense lead was exchanged or an additional pace-sense lead inserted. After extraction, new shock leads were implanted in 14 patients. Major complications occurred in one patient: a pericardial tamponade after perforation of the superior caval vein necessitating acute surgery.

CONCLUSION

Lead extraction with a laser sheath is effective in ICD patients, but major complications can occur. Our current policy with malfunctioning leads is to extract all leads in which insulation defects cannot be ruled out to avoid interference, but to abandon leads that are without insulation defects and properly insulated. In case of infection, extraction remains the primary treatment of choice.