Pitfalls and tips for lumenless lead extraction inserted deep within the ventricular septum

Area of Science:

• Cardiology
• Medical Device Technology
• Electrophysiology

Background:

• Cardiovascular implantable electronic device (CIED) lead extraction can be complex.
• The increasing use of left bundle branch area pacing (LBBAP) presents new challenges for lead management.
• Lumenless pacemaker leads, like the SelectSecure, offer specific implantation benefits but may pose unique extraction difficulties.

Observation:

• A case involving a SelectSecure lumenless permanent pacemaker lead implanted deep within the ventricular septum is presented.
• The lead was deeply embedded, complicating its extraction.
• Despite the challenges, the lead extraction was successfully performed.

Findings:

• Deeply implanted lumenless leads can be difficult to extract due to their design and fixation.
• Specific techniques and careful consideration are required for successful removal of such leads.
• The case underscores the importance of anticipating extraction challenges during initial lead selection.

Implications:

• This case provides practical insights and tips for managing difficult CIED lead extractions, particularly lumenless types.
• It emphasizes the need for meticulous lead selection and pre-procedural planning in the context of evolving pacing strategies like LBBAP.
• Clinicians should be aware of the potential pitfalls associated with lumenless leads and be prepared with appropriate extraction tools and techniques.