PO-04-104 MANAGEMENT OF FROZEN PACEMAKER LEADS IN GENERATOR EXCHANGE

Abstract

As the number of cardiac implantable electronic devices (CIEDs) increases, so does the need for generator exchanges. While rare, chronic pacemaker leads may become frozen in the header or may fracture when removal is attempted. This can lead to unnecessary lead implants and extractions if the lead is damaged while removal is attempted. We present a case and discuss our technique to safely remove these leads without damage to the lead itself during generator exchange. To highlight a technique to manage frozen pacemaker leads during generator exchange. N/A An 89 year old lady presented for elective generator exchange for elective replacement indicator. The leads were 31 years old (Intermedics Pacemakers Inc, Tx). When attempting to unscrew the right ventricular lead, Intermedics model 430-02, the pin became partially separated from the rest of the lead. Thus, the lead was pushed back into the header and a sterile saw was used to remove the header from the tip of the lead. We utilized two surgical clamps to create a guide so the saw stayed in the desired direction. Once the back of the header was cut out, the torque wrench was used to push the pin through intact. Though rare, the increasing number of CIED implants and generator exchanges makes encountering a frozen lead more likely in one’s career and successful management is imperative for patient outcomes, safety, and cost effectiveness. There have been rare reports of similar techniques using a variety of instruments, such as scalpels, drills, and bone cutters, to accomplish a similar effect. We have found a sterile saw to be the most effective way to manage these lead complications safely and effectively.