Percutaneous removal of an inadvertent left-heart implantable cardioverter-defibrillator lead malposition in a nonagenarian: A case report

Figures

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  Figure 1. A: 5-chamber 2-dimensional transthoracic echocardiographic view showing the defibrillator lead positioned in the LV after crossing the aortic valve. B: 12-lead electrocardiogram recorded during pacing threshold testing, revealing a right bundle branch block morphology of the QRS complex. C: Computed tomography scan confirming lead placement within the LV cavity. D and E: Fluoroscopic views in right anterior oblique (D) and left anterior oblique projections (E), illustrating the lead trajectory. LV = left ventricle; RV = right ventricle.

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  Figure 2. Procedural steps to obtain vascular access at the site of the malpositioned lead. A: Surgical incision made in the lead insulation using scissors. B: Insertion of a guidewire between the insulation layer and the conductor coil with the aid of a vein pick. C: Guidewire tip temporarily trapped between the insulation and conductor. D: Advancement of the lead along the ascending aorta while maintaining the guidewire position. E: Release of the guidewire into the subclavian artery lumen to preserve vascular access. F: Balloon catheter inflated adjacent to the arterial injury site to facilitate deployment of the vascular closure device.

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  Figure 3. Angiography performed after the deployment of the vascular closure device demonstrating the absence of contrast extravasation.

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  Supplementary Figure.