A lead extraction procedure commenced to remove a right ventricular (rv) lead due to lead failure.A spectranetics glidelight laser sheath and a lead locking device (lld) were in use.The glidelight device did not progress down to the right ventricle (rv) area; however the physician was able to progress with the glidelight's outer sheath and with use of the lld for traction, down to the area of the rv apex.However, the tip of the lead could not be removed due to adhesion.Counter traction, with aid of the lld, was used to continue attempts to remove rv lead tip; however, patient's blood pressure dropped.A pericardial effusion was confirmed by trans esophageal echocardiography (tee).A tear was confirmed at the rv apex, and a pericardiocentesis was performed and a temporary pacemaker was inserted.The patient was transferred to the or and the lead was removed surgically.After the lead was extracted, a new pacing lead was implanted.The patient survived the procedure.
|