Jugular pacing lead extraction with laser sheath: a case report

Area of Science:

• Cardiovascular Medicine
• Medical Devices
• Infectious Diseases

Background:

• Pacemaker (PM) and implantable cardioverter defibrillator (ICD) use has significantly increased over the last two decades.
• This rise necessitates a growing number of lead-removal procedures, particularly for device infections.
• Infections associated with implanted cardiac devices pose a significant clinical challenge.

Observation:

• A 64-year-old female patient presented with an infected pacemaker pocket and Staphylococcus aureus bacteremia.
• She had a history of VVI pacemaker implantation in 1991 for atrioventricular II degree Mobitz 1 block, with a unipolar lead inserted via the left jugular vein.
• The infected lead required extraction.

Findings:

• The lead removal procedure was successfully performed in the Electrophysiology Lab.
• A cardiac surgeon was on standby during the procedure.
• An excimer laser system, featuring a flexible, fiber-optic 12 F sheath, was utilized for the lead extraction.

Implications:

• This case highlights the successful application of excimer laser technology for complex pacemaker lead extraction in the setting of infection.
• The findings underscore the importance of specialized tools and multidisciplinary collaboration in managing infected cardiac device complications.
• Effective lead extraction is crucial for eradicating infection and improving patient outcomes in cases of device-related morbidity.