Lead management case to extract 4 leads due to fracture, abandonment and total left subclavian occlusion.The physician began the case by prepping the leads, inserting lld ezs and unscrewing the helix on all four leads.Both ra leads were extracted without encountering much resistance.One of the rv leads released while the 14f glidelight laser sheath reached the ra.When the physician went to remove the other rv lead difficulty was met getting the lead to release from the rv apex, the physician then decided to attempt removal through a femoral approach but during preparation a drop in blood pressure was noted.A pericardiocentesis was performed however the drain continued pulling off fluid and the decision was made to perform a sternotomy.A hole in the rv apex was discovered and repaired.During the sternotomy the physician completed the extraction of the remaining rv lead.Two new leads were implanted, the patient survived the intervention.This is being reported on the lld since it was the traction platform in which to remove the lead and the glidelight was not in this area when the injury occurred.
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