TY - JOUR
T1 - A 37-year-old woman with hypertrophic cardiomyopathy with a dual-chamber implantable cardioverter-defibrillator requiring percutaneous transvenous lead extraction and multidisciplinary management
AU - Dhawan, Rahul
AU - Khan, Faris
AU - Samant, Saurabhi
AU - Asawaeer, Majid
AU - Genore, Helenmari Merritt
AU - Erickson, Christopher C.
N1 - Publisher Copyright:
© Am J Case Rep, 2021.
PY - 2021
Y1 - 2021
N2 - Objective: Diagnostic/therapeutic accidents Background: Percutaneous transvenous lead extraction (TLE) of cardiac implantable electronic devices can be performed with a high success rate. However, TLE has its limitations and challenges. Recognizing the challenges at an ear-ly stage during the procedure is vital for appropriate patient management. We present a challenging case of implantable cardioverter-defibrillator (ICD) lead extraction in which we aborted TLE in favor of elective surgical extraction (SE). This potentially prevented a major catastrophic complication of vascular tear, which would have required an emergent thoracotomy. Case Report: A 37-year-old woman with history of hypertrophic cardiomyopathy had a primary prevention dual-chamber ICD implant in 2001 and underwent right ventricular ICD lead revision in 2009 due to lead fracture. In 2019, she was again found to have right ventricular ICD lead malfunction. TLE was attempted, but no meaningful progression could be made despite using multiple extraction tools. Therefore, TLE was aborted in favor of SE. During elective SE, significant adhesions were noted, and the innominate vein was completely avulsed during removal of the leads, requiring venous reconstruction by the vascular surgery team. After SE and vascular re-construction, an epicardial ICD system was placed, and the patient had an uneventful postoperative recovery. Conclusions: This case report highlights the limitations of TLE and the importance of recognizing them in a timely manner. In all challenging cases, conversion to elective SE should be considered to avoid potential injuries warranting emergent surgical repair.
AB - Objective: Diagnostic/therapeutic accidents Background: Percutaneous transvenous lead extraction (TLE) of cardiac implantable electronic devices can be performed with a high success rate. However, TLE has its limitations and challenges. Recognizing the challenges at an ear-ly stage during the procedure is vital for appropriate patient management. We present a challenging case of implantable cardioverter-defibrillator (ICD) lead extraction in which we aborted TLE in favor of elective surgical extraction (SE). This potentially prevented a major catastrophic complication of vascular tear, which would have required an emergent thoracotomy. Case Report: A 37-year-old woman with history of hypertrophic cardiomyopathy had a primary prevention dual-chamber ICD implant in 2001 and underwent right ventricular ICD lead revision in 2009 due to lead fracture. In 2019, she was again found to have right ventricular ICD lead malfunction. TLE was attempted, but no meaningful progression could be made despite using multiple extraction tools. Therefore, TLE was aborted in favor of SE. During elective SE, significant adhesions were noted, and the innominate vein was completely avulsed during removal of the leads, requiring venous reconstruction by the vascular surgery team. After SE and vascular re-construction, an epicardial ICD system was placed, and the patient had an uneventful postoperative recovery. Conclusions: This case report highlights the limitations of TLE and the importance of recognizing them in a timely manner. In all challenging cases, conversion to elective SE should be considered to avoid potential injuries warranting emergent surgical repair.
KW - Defibrillators, implantable
KW - ICD lead extraction
KW - Transvenous lead extraction
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U2 - 10.12659/AJCR.932073
DO - 10.12659/AJCR.932073
M3 - Article
C2 - 34675166
AN - SCOPUS:85117582229
SN - 1941-5923
VL - 22
JO - American Journal of Case Reports
JF - American Journal of Case Reports
IS - 1
M1 - e932073
ER -