Current concepts in extraction of transvenous pacing and ICD leads.

摘要: From the beginning of era implantable devices, there has been a need to remove these devices. The reasons for this have related malfunction, erosion, pocket infection, endocarditis, and host other issues. Although removal subcutaneous or submuscular pulse generator itself is relatively straightforward procedure, transvenous lead system presents significant challenge. 3,10,26,35,43 Progressive growth fibrous tissue around body electrode tip creates major barrier leads. Lead construction evolved from large-diameter solidly built wires, smaller more delicate structurally complex lack tensile strength in some models situation where simply pulling on can result breakage at nearly any part system. Most leads are currently constructed using one helical metallic conductors, but actual configurations widely vary (Fig. 1). These insulated with silicone rubber several types polyurethane. More recently, Teflon coatings applied directly conductor coil other. When doctor pulls lead, insulation limiting factor. If broken breaks during application traction, all that remains (or coils). latter similar coiled spring child's toy known as "Slinky" (Hollidaysburg, PA). Pulling results deformation coils possibly breakage. Though direct traction will leads, it not safe effective many Therefore, tools techniques developed by physicians manufacturers provide technique consistently safely following address pacing defibrillation only. Epicardial (surgically placed outer surface heart) present totally different scenario. Currently, epicardial only be performed surgical approach allows access surface.