Fibrotic tissue growth into the extendable lobes of an active fixation coronary sinus lead can complicate extraction

Extraction of passive fixation coronary sinus (CS) leads is typically easily achieved with manual traction. The ability to readily extract active fixation leads from the CS is less clear. Our first extraction experience with an active fixation CS lead was in a 58-year-old man with a 13-month-old Medtronic 4195 lead (Medtronic Inc., Minneapolis, MN, USA). The lobes of the lead would not fully undeploy. Significant, prolonged manual traction was required to free the lead from the cardiac vein. Inspection demonstrated fibrotic tissue growth into the lead lobes. Such growth may lead to an increase in extraction complications and failures.