A lead extraction procedure commenced to remove a right ventricular (rv) lead, implanted in 2013 due to non function.A spectranetics lead locking device (lld) was placed within the rv lead to provide a traction platform to aid in extraction.The physician started by using a spectranetics 14f glidelight laser sheath but could not advance past the mid clavicular region.He then chose to upsize to a 16f glidelight device, which advanced to the right ventricle near the lead's shocking coil.Immediately, an effusion was detected via transesophageal echocardiography (tee).The patient's blood pressure dropped.Tamponade presented, and a pericardiocentesis was performed via a sub xiphoid thoracotomy.The pressure was successfully relieved and the extraction resumed (please reference mdr 1721279-2021-00010 which captures the effusion which was detected immediately after use of the 16f glidelight device).However, the rv lead was unable to be freed from the rv apex.Subsequently, the rv lead with the lld present inside the lead was cut, capped and remained in the patient's body.The physician attempted to unlock the lld prior to cutting and capping the rv lead, but was unsuccessful.The re-implantation of a new lead was successful and the patient survived the procedure.This report captures the lld which was present within the rv lead and both were cut, capped and remained in the patient's body.
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