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Fluoroscopic images for the extraction of an implantable cardioverter-defibrillator (ICD) lead: (A) baseline image, (B) broken lead with frayed conductors in the tricuspid valve and coil fragment along the superior vena cava, (C) snare attempt with traction from below, (D) lead fragment snared from above, (E) snare attempt with traction from above (note the deformity of the cardiac silhouette before disengagement), and (F) immediately after extraction.
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Background:Atrial fibrillation (AF) can be initiated from arrhythmogenic foci within the muscular sleeves that extend not only into the pulmonary veins but also into both vena cavae. The superior vena cava (SVC) is a key target site for catheter ablation. Patients with SVC-derived AF often lack the clinical risk factors of AF.
Methods and Results:W...
Citations
... In some cases, lead fragments need to be extracted by snaring them with retraction into a sheath [31]. Especially non-metallic components are not visible on X-ray, and ICE allows snaring them successfully. ...
Transvenous lead extraction is an invaluable procedure within the contemporary management of cardiac implantable electronic devices. Transvenous lead extraction has traditionally been guided by fluoroscopy. Complementary imaging with intracardiac echocardiography can provide valuable additional information, such as identification of complications, lead-adherent echodensities, and sites of lead-tissue adherence. As such, it can be used to aid in risk stratification before lead removal, help to choose tools or techniques, and provide visual monitoring throughout the procedure. Intracardiac echocardiography can be incorporated into the lead extraction workflow of the contemporary electrophysiologist and provide valuable information supporting safety and efficacy.
