Published online Feb 16, 2017. doi: 10.12998/wjcc.v5.i2.46
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.
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.