Sharma Chandan, Sharma Gautam
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Pacing Clin Electrophysiol. 2025 May 6. doi: 10.1111/pace.15191.
Transvenous lead extraction (TLE) is recognized as an effective method of lead extraction, but can be challenging with old and tined pacemaker leads.
We present the case of a 44-year-old male with cardiovascular implantable electronic device (CIED) infection who underwent TLE of his 15-year-old tined pacemaker leads using a novel approach. A carotid shuttle sheath with the tip fashioned into a bevel shape was used as a makeshift dilator to dissect and free the leads from adhesions. A bioptome, introduced through the TightRail sheath, was employed to dislodge the right ventricular (RV) lead tip, while a snare introduced subsequently through the same access was used to grip the distal end of the RV lead. The lead was extracted using the snare without the need for additional femoral or jugular access.
To the best of our knowledge, the use of this bioptome and snare technique, through the TightRail sheath, without employing femoral or jugular access for lead extraction, has not been previously reported. This case highlights the importance of innovative techniques in successfully addressing challenging TLE cases.
经静脉导线拔除术（TLE）被认为是一种有效的导线拔除方法，但对于陈旧且有倒刺的起搏器导线而言可能具有挑战性。
我们报告一例44岁男性心血管植入式电子设备（CIED）感染患者，采用一种新方法对其15年的有倒刺起搏器导线进行了TLE。将尖端制成斜面形状的颈动脉穿梭鞘用作临时扩张器，以从粘连中分离并松解导线。通过TightRail鞘引入活检钳以移除右心室（RV）导线尖端，随后通过相同入路引入圈套器以夹住RV导线的远端。使用圈套器成功拔除导线，无需额外的股静脉或颈静脉入路。
据我们所知，此前尚未报道过通过TightRail鞘使用这种活检钳和圈套器技术，且不采用股静脉或颈静脉入路进行导线拔除。该病例突出了创新技术在成功处理具有挑战性的TLE病例中的重要性。
