A 62-year-old man presented with severe pacemaker endocarditis after conservative treatment (pacemaker replacement and partial system removal, contralateral pacemaker implantation) in the context of pocket infection. This strategy leads to a complex lead-extraction procedure.
After generator removal, the two right-sided functioning leads (atrial and ventricular, implanted in 2005) were extracted by a superior transvenous approach using lead-locking devices (LLD ® 2, Spectranetics ® ).
The two left-sided leads, implanted in 1998, cut in their proximal portion in the subclavian vein without possible access by a subclavian approach, were extracted during the same procedure from an inferior, femoral venous approach. The ventricular lead was removed with a Byrd Needle’s Eye Snare ® inserted into a 16-French sheath (Cook ® ). The atrial lead was impossible to remove with a double lasso (the loop was not quite large enough to permit insertion). Using a 6-French angled catheter (multipurpose, Medtronic ® ), inserted into the 16-French sheath, a guide was inserted into the loop over the atrial lead. The guide was caught with the lasso and returned to the skin. The two arms of this self-made lasso were inserted together into the 16-French sheath. Using a strong counter-traction, the atrial lead was extracted successfully.
All leads were extracted without complication. A new permanent epicardial pacemaker was implanted on the same day. There is no debate about the absolute necessity to remove all the leads in case of pacemaker endocarditis . Original tools can be useful for completing a successful lead extraction procedure ( Figs. 1–3 ).
