This was a case to extract three cardiac leads due to bacteremia, cied system/pocket infection.Leads were prepped with spectranetics lead locking devices.The right ventricular lead was heavily calcified resulting in stalled progress of the 14 fr.Glidelight laser sheath near the tricuspid valve.Counter traction was applied to the rv lead and noted the lead felt stiff.At that time, the patient had a drop in blood pressure.The surgeon was notified and a fluoroscopy of the cardiac silhouette showed a cardiac tamponade.Cpr was initiated and one unit of blood given.Pericardiocentesis was done and 50 cc of blood removed.The patient's pressure normalized and the rv lead was removed.It was decided to discontinue the extraction and leave the other two lld's in place.They were not able to be unlocked but were well seated in the leads.The leads and lld's were successfully removed 36 hours later.Based on spectranetics guidelines the contact duration for this device is limited to 48 hours and has not been tested as an implantable device.Lld abandonment is not recommended by spectranetics due to the possibility of vessel or endocardial wall damage from the stiffened lead, fracture of the lld, or migration of the device.These devices were removed within the specified timeframe to reduce bioburden.
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