An 81-year-old man was referred with an infected cardiac resynchronization therapy defibrillator (CRT-D) system, 8 years after initial implantation of a single-chamber implantable cardioverter-defibrillator and 2 years after upgrade of the system to CRT-D. After recurrent erosion, transvenous extraction was attempted with mechanical sheaths, but failed. Attempted surgical extraction via mini-thoracotomy was abandoned as lead traction caused severe hypotension. The leads were cut short and abandoned; a new single-chamber system was implanted on the right. The patient was referred to us with progressive local and systemic infection.
Using a left infraclavicular incision, the atrial lead was extracted using a 9 F Evolution® sheath. The endocardial left ventricular lead was removed via the right femoral vein using a Byrd Workstation™ and a Needle's Eye Snare®. The right ventricular lead was extended using a Bulldog™ Lead Extender, freed from above using an 11 F Evolution Shortie, dragged inferiorly through its atrial and venous attachments using the Byrd Workstation with marked de-spiralling, then grasped using a gooseneck snare (Figure A) and pulled out the right internal jugular vein, from where an 11F Evolution was then used to dissect to the lead tip (Figure B) removing it completely without complication. Recovery was uncomplicated.
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