A philips representative reported that a cardiac lead management procedure commenced.The lead extraction was being performed due to "noise" on the right ventricular (rv) lead.The operative plan was to remove the current cardiac implantable electronic device (cied) and implant a different device.The physician opened the pocket and dissected out the lead.When he took an xray image it was seen that the lead was attached from the clavicle.He then used a spectranetics lead locking device (lld) ez 518-067 which was deployed successfully.Then he used a 13fr spectranetics tightrail rotating dilator sheath.The tightrail advanced, but stopped at the clavicle.From this point, the sheath advanced slowly and with difficulty.The tightrail sheath and the outer sheath were advanced just past the superior vena cava (svc).At this point, despite putting tension on the spectranetics lld ez, the lead did not appear to straighten.At this point it was thought that the lld had slipped back from the tip of the lead.The physician attempted to further manipulate the tightrail sheath and the lld snapped.
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