Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2017; 5(2): 46-49
Published online Feb 16, 2017. doi: 10.12998/wjcc.v5.i2.46
Unexpected challenging case of coronary sinus lead extraction
Luca Bontempi, Donatella Tempio, Raffaella De Vito, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Abdallah Raweh, Lorenza Inama, Francesca Vassanelli, Mario Luzi, Antonio Curnis
Luca Bontempi, Manuel Cerini, Francesca Salghetti, Niccolò Dasseni, Clara Villa, Lorenza Inama, Francesca Vassanelli, Antonio Curnis, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, 25123 Brescia, Italy
Donatella Tempio, Chair and Unit of Cardiology, University of Catania, Ferrarotto Hospital, 95124 Catania, Italy
Raffaella De Vito, Chair and Unit of Cardiology, University of Siena, Santa Maria della Scala Hospital, 53100 Siena, Italy
Abdallah Raweh, Cardiac Surgery, University, 6912 Lugano, Switzerland
Mario Luzi, Chair and Unit of Cardiology, Hospital Riuniti, 60126 Ancona, Italy
Author contributions: Bontempi L contributed to the conception and design of the work, drafting the article, final approval; Tempio D, De Vito R, Cerini M, Salghetti F, Dasseni N, Villa C, Raweh A, Inama L, Vassanelli F, Luzi M, Curnis A contributed to the drafting and critical revision of the work, final approval.
Institutional review board statement: The ethics committee approval is not required by the regulations for case report.
Informed consent statement: Patient’s consent was obtained.
Conflict-of-interest statement: The authors report no relationships that could be construed as a conflict of interest. None to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Luca Bontempi, MD, Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, Piazzale Spedali Civili, 1, 25123 Brescia, Italy.
Telephone: +39-030-3995573 Fax: +39-030-3700359
Received: September 5, 2016
Peer-review started: September 6, 2016
First decision: October 20, 2016
Revised: November 19, 2016
Accepted: December 1, 2016
Article in press: December 2, 2016
Published online: February 16, 2017

An 84-year-old woman implanted with cardiac resynchronization therapy defibrillator underwent transvenous lead extraction 4 mo after the implant due to pocket infection. Atrial and right ventricular leads were easily extracted, while the attempt to remove the coronary sinus (CS) lead was unsuccessful. A few weeks later a new extraction procedure was performed in our center. A stepwise approach was used. Firstly, manual traction was unsuccessfully attempted, even with proper-sized locking stylet. Secondly, mechanical dilatation was used with a single inner sheath placed close to the CS ostium. Finally, a modified sub-selector sheath was successfully advanced over the electrode until it was free of the binding tissue. The post-extraction lead examination showed an unexpected fibrosis around the tip. No complications occurred during the postoperative course. Fibrous adhesions could be found in CS leads recently implanted requiring non-standard techniques for its transvenous extraction.

Keywords: Cardiac resynchronization therapy, Coronary sinus lead, Transvenous lead extraction, Cardiac pacing, Fibrosis

Core tip: Coronary sinus lead extraction is a safe procedure with complication rates comparable to those of the extraction of other leads in experienced centers. The main difficulties may be related to the thickness of the coronary sinus structure and the fibrotic adhesions along it. In this case report we describe an unusual case of persistent fibrosis at the tip of a coronary sinus lead only 4 mo after implantation and the non-standard techniques adopted to achieve successful extraction.