P12 COMPLEX LEAD EXTRACTION: A PERCUTANEOUS MULTIDISCIPLINARY APPROACH

Abstract

Abstract Introduction The infection represents one of the most serious complications of implantable cardiac systems (ICDs and PMs) and is associated with increased mortality and significant expenditure of financial resources. The incidence, which ranges from 0.6 to 3.4%, depends by the patient characteristics, the type of implanted system, and from other factors related to the procedure itself. When diagnosed, it is recommended extraction of the system. A 77–year–old patient, hypertensive, obese, former tobacco user, suffering from chronic ischemic heart disease and carrier of bicameral PM since 2019 for BAV grade III. In June 2022 decubitus of the PM pocket. Considering the negativity of coltural tests and the absence of fever, it was decided to use a conservative approach by doing a curettage of the pocket and by repositioning the device at the submuscular level. After about a month, a reappearance of decubitus with exposure of the PM case occurred, therefore, a complete extraction of the leads and removal of the device was performed. The surgery, performed under general anaesthesia, was complicated by the fracture of both leads at the level of the anonymous vein. With the introduction of dedicated ligature through the right femoral vein, it was possible to successfully extract the ventricular lead stump. During the recapture of the atrial stump, a migration of the stump into the right ventricle and then into the pulmonary circulation to a terminal branch of the right pulmonary artery occurred. The recovery of such stump was possible with the help of interventional radiologists and through the use of a dedicated material (“Gooseneck ligature catheter”). Subsequent implantation of temporary PM by the right jugular given the absence of underlying spontaneous rhythm. Conclusions CIED extraction surgery is burdened with a high risk of complications even serious ones, including lead rupture and distal fragment embolization. A multidisciplinary approach with shared choices and techniques allowed the resolution percutaneous resolution of a complex picture.