A lead extraction procedure commenced to remove a right atrial (ra) lead, a left ventricular (lv) lead and a right ventricular (rv) lead with a hybrid approach of the cardiac resynchronization therapy defibrillator (crt-d) due to pocket decubitus.The physician was able to extract the lv lead using a spectranetics 11f tightrail rotating dilator sheath.The ra lead was removed with use of a spectranetics 16f glidelight laser sheath, after attempts were made using 11f and 13f tightrail devices.The physician encountered difficulty with extraction of the rv lead using the abovementioned devices, along with a spectranetics lead locking device (lld) that was inserted into the rv lead and was providing traction to aid in extraction.After several attempts to remove the rv lead, the physician decided to abandon it within the patient.It was reported that it was impossible to remove the lld from inside the lumen of the rv lead, so the physician cut both the rv lead and the lld contained within the lead, and capped them.The physician then successfully reimplanted the crt-d system from the patient's left side.The patient survived the procedure and there was no reported injury.
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