Successful Transvenous Extraction of Infectious Ventricular Lead Penetrating Through the Ventricular Septum to the Left Ventricle

An 83-year-old man was admitted with pacemaker infection 4 years after implantation for complete atrioventricular block at another hospital. ECG indicated left ventricular (LV) capture, and computed tomography and transthoracic echocardiography revealed that the ventricular lead had penetrated through the ventricular septum to the LV cavity without attachment of thrombus or vegetation (SelectSecure 3830 pacing lead, Medtronik; Figure A–C). Pacemaker pocket debridement and transvenous lead extraction (TLE) were performed. A 12-Fr excimer laser sheath was carefully advanced over the ventricular lead up to the right ventricular septum, the ventricular lead was successfully extracted without residual interventricular shunt flow (Figure D), and the complete device was extracted.

Figure.

(A) Erosion of the pacemaker pocket. (B) ECG showing complete right bundle-branch block morphology with ventricular pacing. (C) Contrast-enhanced computed tomography and transthoracic echocardiography show penetration of the ventricular lead through the ventricular septum to the LV cavity. (D) Successful transvenous lead extraction. LAO, left anterior oblique; LV, left ventricle; RV, right ventricle.

The complication rate of perforation by SelectSecure 3830 pacing leads into the LV cavity is reported as 3.67%.¹ Although surgical procedures are reportedly safe for patients who are unsuitable for TLE,² it is unclear whether perforation of leads into the LV cavity is also unsuitable for TLE. This is the first report of successful TLE of a perforating lead in the LV cavity during the chronic phase. It may be a therapeutic strategy in similar cases.

Disclosures

K.Y. is a member of Circulation Journal’s Editorial Team. The remaining authors have no conflicts of interest to disclose.

Supplementary Files

Supplementary Movie. The fluoroscopic image of transvenous extraction of ventricular lead.

Please find supplementary file(s);

https://doi.org/10.1253/circj.CJ-23-0069

References

• 1.   Jastrzębski M, Kiełbasa G, Cano O, Curila K, Heckman L, De Pooter J, et al. Left bundle branch area pacing outcomes: The multicentre European MELOS study. Eur Heart J 2022; 43: 4161–4173.
• 2.   Miyagi Y, Oomori H, Maeda M, Murata T, Ota K, Motoji Y, et al. Surgical management of cardiac implantable electronic device complications in patients unsuitable for transvenous lead extraction. Circ J 2022; 87: 103–110.