Key result
Extraction of a chronically implanted active-fixation coronary sinus lead was successfully achieved using a 9F mechanical dilator sheath (Evolution), complicated by a transient pericardial effusion.
Case Report (n=1)
Mechanical dilator sheaths can be used to extract chronically implanted active-fixation coronary sinus leads, but carry risks of severe complications and should be used by experienced operators.
May enable extraction of fixed CS leads after failed standard attempts; leaves open safety and reproducibility in larger series.
In this case, a unipolar active-fixation coronary sinus lead (Star Fix®) had to be removed because of severe infection. For lead removal, a venous lead entry site approach with a transvenous mechanical dilator technique was used. However, the lead could not be extracted, as its polyurethane lobes, expanded in the lateral coronary vein, could not be relaxed. A 9F mechanical dilator sheath (Evolution®), was then advanced through the coronary sinus into the lateral coronary vein. It was possible to reach the tip of the StarFix® and to extract the entire lead. Immediately after the procedure, a discrete pericardial effusion was seen. This effusion disappeared without the need for pericardiocentesis within 3 days. Extraction of chronically implanted active-fixation coronary sinus leads can be extremely challenging. Within the coronary sinus or coronary veins, mechanical dilator sheaths like the Evolution® should only be used by experienced operators because of potential risks for severe complications. Thus, active-fixation coronary leads should only be implanted, if there are no other options. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/removal-of-a-chronically-implanted.pdf.
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Kypta et al. (2014) conducted a case report in Severe infection of a chronically implanted active-fixation coronary sinus lead (n=1). Lead extraction using a 9F mechanical dilator sheath (Evolution) was evaluated on Successful extraction of the entire lead. Extraction of a chronically implanted active-fixation coronary sinus lead was successfully achieved using a 9F mechanical dilator sheath (Evolution), complicated by a transient pericardial effusion.
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