Why the study?
Transvenous lead extraction is standard for cardiac device-related infection, but in some patients a hybrid surgical and transvenous approach may be necessary.
Case Report (n=3)
A hybrid transvenous and surgical approach can be successfully used to extract coronary sinus leads with severe fibrosis that fail transvenous extraction.
Hybrid approaches may aid select CRT-D infections with fibrotic CS leads; case reports leave open optimal strategies and safety data.
BACKGROUND: Transvenous lead extraction is the standard therapy for cardiac device-related infection. In some patients, however, a hybrid surgical and transvenous approach may be necessary. METHODS AND RESULTS: We present three cases who underwent transvenous lead extraction for an infected CRT-D system. In all cases the CS lead could not be retrieved transvenously due to extensive fibrosis. The lead was successfully extracted through left minithoracotomy in two patients and midline sternotomy in one patient. CONCLUSION: In cases where the coronary sinus lead shows severe fibrosis, a transvenous approach can be used to free the proximal part of the lead, while the distal adhesions can be removed surgically through a limited thoracic incision.
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Ahmed et al. (2022) conducted a case report in Infected CRT-D system requiring coronary sinus lead extraction (n=3). Hybrid surgical and transvenous approach was evaluated on Successful lead extraction.
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