Surgical Removal of Entrapped Endocardial Leads Without Using Extracorporeal Circulation*

Abstract

Of 267 patients having a tined endocardial lead implanted from 1978 to December 1983, three (1.1%) developed pulse generator pocket infection. Proper treatment of this complication involves removal of the pulse generator, continued external pacing via the implanted lead, pocket drainage and administration of specific antibiotics until the infected area clears. In two patients, the electrode could not be removed by traction. A sternotomy was performed, the pericardium was opened, the endocardial electrode was located by palpation, and a purse string suture (PSS) was prepared around it on the right ventricular wall. A new myocardial electrode with its corresponding generator was then implanted to reestablish pacing. Through the PSS the myocardium was incised, the distal end of the endocardial lead was exteriorized and severed, and the PSS was tied. The remaining lead was withdrawn proximally and the surgical wounds were closed. The results of this procedure have been been excellent, allowing the removal of the entrapped leads, with continuous pacing and without the need for extracorporeal circulation.

Extraction of Transvenous Pacing and ICD Leads

“…Cutting the proximal portion of the lead and allowing it to retract into the central circulation such that it is inaccessible via the venous entry site is inappropriate and should be avoided in any situation (pocket infection or endocarditis). Subsequent attempts at lead removal are made far more difficult, often requiring a femoral or transatrial approach 8–16 . An increasingly common clinical problem is that of vegetations, which can occur with implanted leads.…”

Untitled

“…[4][5][6][7] The old techniques of external traction using weights, pulleys, and adhesive tape had limited success and an abundance of serious complications. Until very recently, the only methods available for removing chronically implanted leads were traction or cardiac surgical procedures with or without a bypass.…”

Percutaneous Treatment for Pacemaker‐Associated Superior Vena Cava Syndrome

“…[3][4][5] However, when these are complicated with SVC syndrome, surgical removal and reimplantation of pacing leads, together with venous reconstruction has been the standard treatment. 6,7 This article reports the authors' initial experience with a percutaneous approach that consists of extraction of the pacemaker system with an excimer laser sheath, followed by percutaneous venous revascularization and stent placement, and implantation of a new pacemaker generator and leads with the same venous access.…”