Difficult dual stage transcutaneous lead extraction complicated by fracture of both leads

Extraction of two long-implanted (11 year-old) active leads due to local infection was complicated by the fracture of both leads with a metal sheath. The presence of a temporary pacing lead, inserted due to pacemaker dependence, made extraction even more difficult. The fixation of both proximal extracted lead endings in the occluded subclavian vein was much stronger than the connection of the tips of the leads with the RAA and RVA endocardium. The disintegration of both leads caused by drawing upon the distal ending added additional technical complications to the final procedure. The presented case underscores the necessity of having a full set of tools to hand even during what appears to be a routine lead extraction procedure. The importance of proper lead implantation on its extraction (in what may be the distant future) is discussed.