Transvenous Lead Extraction in Adult Patient with Leads Implanted in Childhood-Is That the Same Procedure as in Other Adult Patients?

Figures

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  Figure 1. Straightening of the leads due to body growth (A–D). The unnatural course of the electrode is a common phenomenon in the analyzed population of patients. Adherence of the lead to the vein and heart structures induces scar formation and makes it difficult to extract the lead. Epicardial lead remnants (C) and endocardial led remnants (after previous TLE) (A) are frequent findings in patients with leads implanted in childhood. (B) strained RV lead, during unit replacement atrial lead in atypical tip position was added (D) straightening of the leads, no other pathology is seen.

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  Figure 2. Another trap of lead extraction in young adults—redundant lead slack (but planned) resulting in strong adherence to the heart structures (examples A–D). It increases the risk of targeted lead fracture, atrial wall rupture or injury to the tricuspid apparatus. Lead slack to allow for growth was supposed to prevent lead straightening, but his technique did not live up to expectations and was abandoned. (A) VVI pacing system. Old unnecessary (but made on purpose) lead loop located in RA and RVOT. (B) DDD pacing system. Proper atrial lead route and loop on ventricular lead finally located in RVOT. (C) DDD pacing system two leads, two loops (D) Another one DDD system. Proper atrial lead course and loop of ventricular lead finally located in RVOT. Presence of old models of passive leads indicates for more difficult extraction.

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  Figure 3. Common preoperative radiological imaging of adult patients with leads implanted in childhood, reflecting their history of electrotherapy in the form of remnants of lead fragments after TLE (A), abandoned leads (B,D) or unnecessary lead loops in the heart, which did not prevent constant pulling on the RV apex and partial destruction of BP passive lead (unnaturally increased tip-ring distance) (C). (A) Remnants of lead fragments after previous TLE. (B) Presence abandoned lead opposite chest side. (C) Two abnormal lead in right atrium, partial destruction of BP passive lead (unnaturally increased tip-ring distance). (D) Two abandoned leads left side of the chest. Redundant lead slack (but planned) generates risk of strong adherence to heart structures and to both functional leads and finally-very difficult extraction.