https://orcid.org/0000-0002-3257-8216
The extraction of migrating leads is technically challenging, especially when a superior vena cava (SVC) coil was left alone in the innominate vein.
A 56-year-old man with Brugada syndrome developed a delayed cardiac tamponade due to perforation of the right ventricle (RV) defibrillation lead (Riata 1580, Abbott) implanted 10 years ago. The RV was surgically repaired, and the RV lead was resected at the right atrium (RA) level. One year later, he was referred to our hospital to undergo lead extraction due to pocket infection. A locking stylet was developed at the lead’s distal end, which could not be captured by a snare catheter inserted via the femoral access because the distal end was resected just below the level adherent to the RA. A 14-Fr laser sheath was advanced to one-third of the SVC coil when the lead was broken (Panel A). The snare catheter was advanced to the innominate vein to grab the proximal end of the SVC coil (Panel B). The proximal coil was seized using the snare with the support of the deflectable catheter inserted from the internal jugular vein (Panel C), and the coil was moved into the jugular vein (Panel D; Supplementary material online, Video S1). The coil was grabbed with the snare catheter advanced via the internal jugular access, but the coil was easily untied gradually by pulling it (Panel E; Supplementary material online, Video S2). With continuous mild traction, the entire coil was finally pulled out of the body. The SVC coil with massive adhesion (arrows) had been untied almost entirely (Panel F).
Supplementary material
Supplementary material is available at European Heart Journal – Case Reports online.
Consent: The authors confirm that witnessed verbal consent for submission and publication of this case report, including images and associated text, has been obtained from the patient. This has been discussed with the editors.
Funding: None declared.
Data availability
The data sets used and/or analysed during the current study are available from the corresponding author upon reasonable request.
Author notes
Conflict of interest: K.K. reports grants from Medtronic Co., Ltd, and Abbott Medical Japan LLC. A.S. reports grants from Abbott Medical Japan LLC. Y.S. reports grants from Philips Japan, Ltd, and Abbott Medical Japan LLC. No other authors have a real or perceived conflict of interest.
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