Snare-induced deflection of a powered mechanical sheath for refractory right ventricular lead extraction with severe distal adhesion: the SIT-DOWN technique

In young patients with long-standing transvenous cardiac device leads, particularly implantable cardioverter-defibrillator (ICD) leads, lead extraction is often difficult owing to calcification or severe adhesions.1,2 In these cases, maintaining coaxial alignment during lead extraction is one of the most critical factors. Although techniques such as countertraction and snaring have been reported to maintain coaxiality,3 it may remain difficult when dense adhesions fix the lead to surrounding tissues.