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Case Reports
. 2024 Aug 25;16(8):e67737.
doi: 10.7759/cureus.67737. eCollection 2024 Aug.

Extraction and Reimplantation of a Subcutaneous Implantable Cardioverter Defibrillator: Two Cases and a Review of the Literature

Cyrus Moini  1   2 , Jaouad Nguadi  1 , Djamila Rahim  2 , Audrey Lefoulon  1 , Damien Poindron  3 , Antonio Fiore  4 , Thierry Folliguet  4 , Nicolas Lellouche  5
Affiliations
Case Reports

Extraction and Reimplantation of a Subcutaneous Implantable Cardioverter Defibrillator: Two Cases and a Review of the Literature

Cyrus Moini et al. Cureus. .

Abstract

For several years, implantable cardioverter defibrillators (ICDs) have been the cornerstone for the prevention of sudden cardiac death. However, the weakness of traditional transvenous ICD systems lies in the intravascular lead, which is prone to issues such as conductor fracture, insulation abrasion, risk of dislodgement, and infection. With the new generation of subcutaneous defibrillators, these risks are far less common. To date, the frequency of lead fracture is very low, and infection is much rarer. The management of these complications requires complete lead extraction. Traction is the reference procedure, sometimes necessitating the use of a dilating sheath. These techniques remain straightforward to perform without significant risk of procedural complications. Nevertheless, they must be carried out by an expert in cardiac pacing. We report here two cases with indications for lead extraction: one for lead dysfunction and the other for an infection related to a replacement procedure. The management approaches will be described, followed by a review of the literature.

Keywords: infection; lead extraction; lead fracture; subcutaneous implantable cardioverter defibrillator; traction.

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Conflict of interest statement

Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. (A) Flat alternate vector, (B) primary vector, and (C) secondary vector, similar to the primary vector. (D) Event classified as VT with delivered therapy showing mechanical artifacts.
Figure 2
Figure 2. Fracture point of the lead, distal to the proximal electrode. In red: The two incisions made. Arrow: Direction of extraction through the supplementary distal incision. In green: New tunneling 1 cm away from the initial lead.
Figure 3
Figure 3. Top: Extracted lead with the dilator sheath through the distal incision. Bottom: Lead extracted in two pieces with the dilator sheath. Red arrows indicate the fracture point. Orange arrows indicate the direction of extraction.
Figure 4
Figure 4. Images of the Spectranetics TightRail progression with continuous tension on the wire.
Figure 5
Figure 5. Indications for subcutaneous lead extraction.
From ref [8].
Figure 6
Figure 6. Methods of subcutaneous lead extraction.
From ref [8].
See this image and copyright information in PMC

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