Asymptomatic superior vena caval occlusion: a complication of nonthoracotomy implantation of cardioverter defibrillator

Extraction of endocardial implantable cardioverter-defibrillator leads

Despite a growing number of implantable cardioverter-defibrillator (ICD) lead removal indications, there is no consensus about extraction techniques. We applied our experience of pacemaker lead removal to ICD leads using a superior approach with a standard extractor kit, and an inferior approach with a lasso, or a surgical extraction. Fifteen leads were removed in 11 patients during 12 procedures (1 patient was referred twice): 11 right ventricular defibrillation leads, 3 right atrial coils, and 1 atrial lead implanted with a DDD-ICD. The indication for lead extraction was insulation failure (n = 4), conductor fracture (n = 2), abdominal pocket infection (n = 4), lead endocarditis (n = 1), and replacement of an atrial coil by an atrial lead for DDD-R pacing (n = 1). One patient had surgical extraction of 2 leads because of an endocarditis with large vegetations on a DDD-ICD. In 11 other cases, 5 leads were removed using a superior approach with a standard extraction kit and 8 leads were removed by a femoral approach using a lasso alone or added to a pigtail catheter. There was no failure of explantation. One extraction attempt failed with the superior approach but was successful with a secondary inferior approach. The main difficulties encountered were due to tight adherence of the proximal coil to the venous wall and to dislodgment of passive fixation leads from their endocardial insertion. One patient had subclavian vein thrombosis after intervention; no major complication was noted. Ten patients immediately underwent reimplantation. Two patients (1 with an endocarditis and 1 free of ICD therapy for 5 years) did not have reimplantation. During a 4- to 44-month follow-up, no late complication appeared. Thus, ICD lead explantation can be performed with a good success rate, with extraction techniques similar to those used for pacemaker leads.