Right-to-left tunneling of an existing atrial lead with a new left-sided defibrillator lead resulted in clinical stability and full CIED functionality over a 2-year follow-up.
Case Report (n=1)
Is a right-to-left tunneling bail-out strategy feasible and safe for complex ICD upgrade in a pacemaker-dependent patient with venous occlusion?
Right-to-left tunneling of an existing atrial lead combined with a new left-sided defibrillator lead is a feasible bail-out strategy for pacemaker-dependent patients with venous occlusion undergoing ICD upgrade.
Inadequate vein access is a frequent obstacle during cardiac implantable electronic device (CIED) upgrade procedures; thus, bail-out strategies are employed. A 71-year-old male with dilated cardiomyopathy bearing a 7-year-old right-sided dual-chamber pacemaker was scheduled for upgrade to an implantable cardioverter defibrillator. The case presented two main challenges—first, pacemaker dependency, and second, an occluded right subclavian vein. In a shared decision-making approach, the decision was made to “abandon” the right-sided ventricular lead in situ, reposition the right-sided atrial lead by tunneling over the sternum into the left pectoral area, and implant a new left-sided defibrillator lead. During the 2-year follow-up our patient remained clinically stable and the CIED fully functional. Herein, beyond case presentation we also elaborate on individualized alternative treatment strategies for patients with venous access site occlusion in a literature review.
Vrachatis et al. (Sun,) conducted a case report in Dilated cardiomyopathy with pacemaker dependency and occluded right subclavian vein (n=1). Right-to-left tunneling of the right-sided atrial lead and implantation of a new left-sided defibrillator lead was evaluated on Clinical stability and CIED functionality. Right-to-left tunneling of an existing atrial lead with a new left-sided defibrillator lead resulted in clinical stability and full CIED functionality over a 2-year follow-up.