1/6. Exchange of pacing or defibrillator leads following laser sheath extraction of non-functional leads in patients with ipsilateral obstructed venous access.Occlusion of the subclavian or brachiocephalic vein in pacemaker or defibrillator patients prohibits ipsilateral implantation of new leads with standard techniques in the event of lead malfunction. Three patients are presented in whom laser sheath extraction of a non-functional lead was performed in order to recanalise the occluded vein and to secure a route for implantation of new leads. This technique avoids abandoning a useful subpectoral site for pacing or defibrillator therapy. The laser sheath does not affect normally functioning leads at the same site.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/6. Repositioning of a dislodged and fibrosed ventricular lead.This is a case of a 61 year old African American female with history of end stage renal disease on hemodialysis. She had a dual chamber permanent pacemaker implanted in 2003 for symptomatic bradycardia. Over the past several months the patient had problems with access for dialysis. The right arm AV fistula was occluded. The patient had multiple temporary central catheter placed for dialysis over the past 3 months. The patient was admitted for superior vena-cava syndrome. CT scan of the thorax and neck showed occluded right and left subclavian system. An incidental finding was the right ventricular (RV) lead been dislodged and the tip being in the inferior vena cava. Surgical and non-surgical options were discussed with the patient and she chose to go the less invasive route. The patient underwent a RV lead revision. Using different stylets the RV lead was repositioned in the RV with good pacing and sensing characteristics. CONCLUSIONS: Successful repositioning of an old dislodged RV pacing lead using stylets and eliminating the need for invasive procedure like lead extraction.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
3/6. Percutaneous extraction of a fractured permanent pacemaker lead with no free end.From various points of view abandoned or displaced permanent pacemaker leads should be extracted in indicated cases using a broad spectrum of catheter-based techniques. We describe a relatively easy extraction procedure of almost the whole pacemaker lead, which broke near the pulse generator and migrated into right-heart chambers; so both ends were indwelling. The described procedure was undertaken using a simple homemade nitinol-based extractor.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/6. Extraction of a chronically infected endocardial screw-in pacemaker lead by pigtail catheter and wire loop via the femoral vein.A 71-year-old woman was admitted after partial removal of an infected pacemaker system. Septicemia and subclavian vein thrombosis were present. With combined use of a pigtail catheter and a wire loop originally developed for endoscopic polypectomy, the infected catheter was pulled into the inferior vena cava. Counterclockwise rotation of the pigtail catheter following its fixation to the electrode by the wire loop allowed removal of the tip of the endocardial screw-in electrode from the myocardium and its extraction. Open heart surgery was avoided and the source of chronic infection was removed.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
5/6. Tooth extractions and sick sinus syndrome.The experience of tooth extraction in four patients with sick sinus syndrome (SSS) is described, and electrocardiographic features and a guideline for dental extractions are discussed. patients controlled by medical therapy were safely treated under administration of an effective drug prior to treatment, while patients with a cardiac pacemaker were examined and checked on the apparatus before tooth extraction by their own specialist. After freedom from the cardiac problems, dental extractions were done smoothly. Electrocardiographically, in the cases with pharmacological treatments, either normal sinus rhythm revealed after additional administration of isoproterenol, or more severe bradycardia-tachycardia pattern was shown immediately after tooth extraction. In the patients with a cardiac pacemaker, ECG presented patterns controlled by pacemaker but beats rose from their own sinus node in the anesthesia-extraction procedure with various grades.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
6/6. lead extraction in young patients with and without congenital heart disease using the subclavian approach.Pacemaker lead removal using interlocking stylets and dilator sheaths has greatly reduced the need for major surgical intervention when lead extraction is required. Previous reports have shown the utility of this method in older patients, most of whom have anatomically normal hearts. The purpose of this study is to report the results of this technique in young patients with and without congenital heart disease. There were 13 patients (M:F = 7:6) aged 9-26 years (median 13). Congenital heart disease was present in 8 of 13 patients. A total of 17 leads required removal; they had been implanted for 54 /- 24 months (range 19-94). Leads were removed from the left subclavian vein (13) or right subclavian vein (4) only. Seventeen of 18 leads were completely removed and one partially retained in the left subclavian vein. New leads were implanted from the same vein in 11 of 13 patients. Interlocking stylets and metal or flexible dilator sheaths were used in all cases except two. There was one surgical complication: a late wound dehiscence, which was easily managed. No patient required a transfusion, and there was no structural damage noted in any patient on the postoperative echocardiogram. We conclude that lead removal using interlocking stylets and dilator sheaths from the subclavian approach is an effective technique that can be used in young patients, including those with congenital heart disease.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |