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Successful transvenous lead extraction using the Evolution System in a 17-kg child
Yakup Ergül1, İsa Özyılmaz2, Alper Güzeltaş2
1Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, İstanbul, Turkey. yakupergul77@hotmail.com.
Insights
Pacemaker lead extraction in children is challenging. A novel system using a thin, lumenless lead successfully extracted a pacemaker in a pediatric patient, reducing venous obstruction risk.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Pacemaker lead extraction in pediatric patients presents unique challenges due to limited data and high complication risks.
- Congenital heart disease and patient growth can complicate existing pacemaker systems.
Observation:
- A 7-year-old male with a history of complete atrioventricular block treated with a pacemaker since infancy presented with lead issues.
- The patient exhibited growth-related lead tension, severe tricuspid insufficiency, and a weak pacemaker battery.
Findings:
- Successful transvenous extraction of the existing pacemaker lead was performed using the Evolution System.
- A new dual-chamber pacemaker with a SelectSecure lead was implanted, demonstrating feasibility in a low-weight pediatric patient.
- The lumenless SelectSecure lead potentially mitigates the risk of venous obstruction.
Implications:
- This case highlights a viable approach for pacemaker lead extraction in complex pediatric cases, including those with congenital heart disease.
- The use of advanced extraction systems and novel lead designs like the SelectSecure lead may improve outcomes for pediatric patients.
- Further research is warranted to validate the long-term safety and efficacy of this approach in the pediatric population.
Abstract:
Despite technological advancements in the field of pacemaker lead extraction, available data on pediatric patients is limited, and risk of failure and severe complications remains high. In this report, we present the case of a male patient who, at five months old, had been transvenously implanted with a single-chamber ventricular pacemaker due to complete atrioventricular block. At 7-year of age, the patient was referred to us with growth-related lead tension, severe tricuspid insufficiency, and weak battery. We extracted the lead using the Evolution System and replaced the unit with a dual-chamber pacemaker with a SelectSecure lead. This new system can be used for lead extraction even in low-weight pediatric patients with congenital heart disease. Using a thin, lumenless SelectSecure lead appears to reduce the risk of venous obstruction.
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