Interactive Case Studies in Lead Extraction John Andriulli, DO, FACC Assistant Professor of Medicine Director of Arrhythmia Device Program Cooper University.

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Presentation transcript:

Interactive Case Studies in Lead Extraction John Andriulli, DO, FACC Assistant Professor of Medicine Director of Arrhythmia Device Program Cooper University Hospital

52 y/o M ICM EF 10-15% ICD implant 2006 Leads: 4076, 6949 NYHA III with new LBBB Referral for upgrade to BiV-ICD CASE 1 84 y/o M ICM EF 25% ICD implant 2007 Leads: 4076, 4194, 6949 NYHA Class III, Chronic AF, CKD (Creat 2.6) AV nodal Ablation Fidelis lead fracture CASE 2 74 yo M ICM EF 25% BiV ICD 2006, Hx SCD Leads: 4076, 4194, 6949 Recurrent ICD therapy appropriate Referral for ERI CASE 3

Factors in Decision Making Patient’s age Patient’s age at implant Lead age Fracture location Pacing dependency Therapy dependency Co-morbidities Patient Anxieties Type of Lead Location of Lead

Leave Fidelis & No new Lead Case 1: Patient’s Options Leave Fidelis & Implant New ICD lead Extract Fidelis & Implant New ICD lead Abandon Leads & Implant contralateral 52 y/o M ICM EF 10-15% ICD implant 2006 Leads: 4076, 6949 NYHA III with new LBBB Referral for upgrade to BiV-ICD

Leave Fidelis & No new Lead Case 1: Patient’s Options Leave Fidelis & Implant New ICD lead Extract Fidelis & Implant New ICD lead Abandon Leads & Implant contralateral 52 y/o M ICM EF 10-15% ICD implant 2006 Leads: 4076, 6949 NYHA III with new LBBB Referral for upgrade to BiV-ICD

Leave Fidelis & No new Lead Case 2: Patient’s Options Cap Fidelis & Implant New ICD lead Extract Fidelis & Implant New ICD lead Cap Leads & Implant contralateral Cap Fidelis & Implant P-S Lead 84 y/o M ICM EF 25% ICD implant 2007 Leads: 4076, 4194, 6949 NYHA Class III, Chronic AF, CKD (Creat 2.6) AV nodal Ablation Fidelis lead fracture

Leave Fidelis & No new Lead Case 2: Patient’s Options Cap Fidelis & Implant New ICD lead Extract Fidelis & Implant New ICD lead Cap Leads & Implant contralateral Cap Fidelis & Implant P-S Lead 84 y/o M ICM EF 25% ICD implant 2007 Leads: 4076, 4194, 6949 NYHA Class III, Chronic AF, CKD (Creat 2.6) AV nodal Ablation Fidelis lead fracture

Leave Fidelis & No new Lead Case 3: Patient’s Options Cap Fidelis & Implant New ICD lead Extract Fidelis & Implant New ICD lead Cap Leads & Implant contralateral 74 yo M ICM EF 25% BiV ICD 2006, Hx SCD Leads: 4076, 4194, 6949 Recurrent ICD therapy appropriate Referral for ERI

Leave Fidelis & No new Lead Case 3: Patient’s Options Cap Fidelis & Implant New ICD lead Extract Fidelis & Implant New ICD lead Cap Leads & Implant contralateral 74 yo M ICM EF 25% BiV ICD 2006, Hx SCD Leads: 4076, 4194, 6949 Recurrent ICD therapy appropriate Referral for ERI

Case 4 50 yo F with CHB s/p dual chamber ppm 5 yrs ago leads. She recently had a TIA (aphasia, R sided weakness) and found to have a para-pituitary brain mass on imaging. Her ppm prevented MRI studies. She was evaluated by neurosurgery at John’s Hopkins however she was denied MRI protocol. Neurosurgery recommended replacement of current device with MRI compatible system.0