Alexander Rusanov, MD, Henry M. Spotnitz, MD

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Presentation transcript:

A 15-Year Experience With Permanent Pacemaker and Defibrillator Lead and Patch Extractions Alexander Rusanov, MD, Henry M. Spotnitz, MD The Annals of Thoracic Surgery Volume 89, Issue 1, Pages 44-50 (January 2010) DOI: 10.1016/j.athoracsur.2009.10.025 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Chest roentgenograms were taken (A) before and (B) after extraction of infected epicardial internal cardiac defibrillator (ICD) patches (black arrows). The tips of the epicardial rate-sensing leads could not be completely extracted for technical reasons (white arrow), and this patient ultimately developed recurrent infection after a new ICD was inserted. Patches were extracted via bilateral thoracotomies. The Annals of Thoracic Surgery 2010 89, 44-50DOI: (10.1016/j.athoracsur.2009.10.025) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Chest roentgenograms were taken (A) before and (B) after extraction of infected epicardial ICD patches (black arrows). The tip of an endocardial rate sensing lead was avulsed in the left subclavian vein during extraction (white arrow). The 2 rate-sensing leads and the superior vena cava coil were extracted percutaneously. The 2 epicardial patches were extracted by bilateral thoracotomies. This patient was not pacemaker-dependent, and a new endovascular ICD lead was inserted 1 week after the extraction. This patient was completely cured. The Annals of Thoracic Surgery 2010 89, 44-50DOI: (10.1016/j.athoracsur.2009.10.025) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Relationship is shown between lead dwell time and retention of lead fragments in the endovascular space. A linear regression line (dashed line) is superimposed. The Annals of Thoracic Surgery 2010 89, 44-50DOI: (10.1016/j.athoracsur.2009.10.025) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Figure 4 Chest roentgenograms were taken (A) before and (B) after extraction of an infected pacemaker system, including a 24.75-year-old lead (black arrow). One lead tip (white arrow) was avulsed and retained in the right ventricular wall during percutaneous extraction. A new device was simultaneously implanted on the contralateral side because the patient was pacemaker-dependent. This patient was permanently cured. The Annals of Thoracic Surgery 2010 89, 44-50DOI: (10.1016/j.athoracsur.2009.10.025) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions