Interactive Case Studiesin Lead Extraction

John Andriulli, DO, FACCAssistant Professor of Medicine

Director of Arrhythmia Device ProgramCooper University Hospital

52 y/o M

ICM EF 10-15%

ICD implant 2006

Leads: 4076, 6949

NYHA III with new LBBB

Referral for upgrade to

BiV-ICD

CASE 184 y/o M

ICM EF 25%

ICD implant 2007

Leads: 4076, 4194, 6949NYHA Class III, Chronic AF, CKD (Creat 2.6)

AV nodal Ablation

Fidelis lead fracture

CASE 2

74 yo M

ICM EF 25%

BiV ICD 2006, Hx SCDLeads: 4076, 4194, 6949

Recurrent ICD therapy appropriate

Referral for ERI

CASE 3

Factors in Decision Making

•Patient’s age

•Patient’s age at implant

•Lead age

•Fracture location

•Pacing dependency

•Therapy dependency

•Co-morbidities

•Patient Anxieties

•Type of Lead

•Location of Lead

Leave Fidelis & No new Lead

Case 1: Patient’s Options

Leave Fidelis & Implant New ICD lead

Extract Fidelis & Implant New ICD lead

Abandon Leads & Implant contralateral

52 y/o M

ICM EF 10-15%

ICD implant 2006

Leads: 4076, 6949

NYHA III with new LBBB

Referral for upgrade to

BiV-ICD

Leave Fidelis & No new Lead

Case 1: Patient’s Options

Leave Fidelis & Implant New ICD lead

Extract Fidelis & Implant New ICD lead

Abandon Leads & Implant contralateral

52 y/o M

ICM EF 10-15%

ICD implant 2006

Leads: 4076, 6949

NYHA III with new LBBB

Referral for upgrade to

BiV-ICD

Leave Fidelis & No new Lead

Case 2: Patient’s Options

Cap Fidelis & Implant New ICD lead

Extract Fidelis & Implant New ICD lead

Cap Leads & Implant contralateral

Cap Fidelis & Implant P-S Lead

84 y/o M

ICM EF 25%

ICD implant 2007

Leads: 4076, 4194, 6949NYHA Class III, Chronic AF, CKD (Creat 2.6)

AV nodal Ablation

Fidelis lead fracture

Leave Fidelis & No new LeadCase 2: Patient’s Options

Cap Fidelis & Implant New ICD lead

Extract Fidelis & Implant New ICD lead

Cap Leads & Implant contralateral

Cap Fidelis & Implant P-S Lead

84 y/o M

ICM EF 25%

ICD implant 2007

Leads: 4076, 4194, 6949NYHA Class III, Chronic AF, CKD (Creat 2.6)

AV nodal Ablation

Fidelis lead fracture

Leave Fidelis & No new Lead

Case 3: Patient’s Options

Cap Fidelis & Implant New ICD lead

Extract Fidelis & Implant New ICD lead

Cap Leads & Implant contralateral

74 yo M

ICM EF 25%

BiV ICD 2006, Hx SCDLeads: 4076, 4194, 6949

Recurrent ICD therapy appropriate

Referral for ERI

Leave Fidelis & No new Lead

Case 3: Patient’s Options

Cap Fidelis & Implant New ICD lead

Extract Fidelis & Implant New ICD lead

Cap Leads & Implant contralateral

74 yo M

ICM EF 25%

BiV ICD 2006, Hx SCDLeads: 4076, 4194, 6949

Recurrent ICD therapy appropriate

Referral for ERI

Case 4

50 yo F with CHB s/p dual chamber ppm 5 yrs ago. 1688 leads.

She recently had a TIA (aphasia, R sided weakness) and found to have a para-pituitary brain mass on imaging.

Her ppm prevented MRI studies.

She was evaluated by neurosurgery at John’s Hopkins however she was denied MRI protocol.

Neurosurgery recommended replacement of current device with MRI compatible system.0