Extraction of endocardial implantable cardioverter-defibrillator leads

Despite a growing number of implantable cardioverter-defibrillator (ICD) le ad removal indications, there is no consensus about extraction techniques. We applied our experience of pacemaker lead removal to ICD leads using a su perior approach with a standard extractor kit, and an inferior approach wit h a lasso, or a surgical extraction. Fifteen leads were removed in 11 patie nts during 12 procedures (1 patient was referred twice): 11 right ventricul ar 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), lea d 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 b ecause 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 extra ction kit and 8 leads were removed by a femoral approach using a lassa alon e or added to a pigtail catheter. There was no failure of explantation. One extraction attempt failed with the superior approach but was successful wi th a secondary inferior approach. The main difficulties encountered were du e to tight adherence of the proximal coil to the venous wall and to dislodg ment of passive fixation leads from their endocardial insertion, One patien t had subclavian vein thrombosis after intervention; no major complication was noted. Ten patients immediately underwent replantation. Two patients (1 with an endocarditis and 1 free of ICD therapy for 5 years) did not have r eimplantation. During a 4- to 44-month follow-up, no late complication appe ared. Thus, ICD lead explantation can be performed with a good success rate , with extraction techniques similar to those used for pacemaker leads. (C) 1999 by Excerpta Medica, Inc.