From Failure to Success: Lithotripsy Transforms Lead Extraction in a Same-Patient Case

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Cardiac implantable electronic device (CIED) infections often require lead extraction, a procedure complicated by calcified adhesions.
• These calcifications increase procedural risk and reduce the efficacy of traditional lead extraction methods.
• Intravascular lithotripsy (IVL) is an emerging technology explored for its potential to address calcification during lead extraction.

Observation:

• A patient with a dual-chamber pacemaker experienced recurrent bacteremia due to infected leads with extensive calcification.
• An initial transvenous lead extraction (TLE) attempt was unsuccessful due to the severe calcification encasing the leads.
• A subsequent extraction attempt utilized IVL to disrupt the calcified adhesions.

Findings:

• Shockwave IVL was applied to the calcified adhesions around the pacemaker leads.
• The lithotripsy pulses successfully fractured the calcification, allowing for sheath advancement and lead mobilization.
• Both atrial and ventricular leads were ultimately extracted without major complications.

Implications:

• This case represents the first documented use of IVL for successful CIED lead extraction in a patient with severe calcification after a failed initial attempt.
• IVL demonstrates significant potential in managing complex lead extraction scenarios with challenging calcified anatomy.
• This technique may improve success rates and reduce risks in high-risk CIED extraction procedures.