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A hybrid ICD extraction approach using laser and transfemoral extraction technique.

Indications for pacemaker and implantable cardioverter defibrillator (ICD) implantations are rapidly expanding. Hence, device-related complications have increased the need for lead extraction. Lead extractions are performed percutaneously or by open surgery.

We present a patient with isolated left ventricular noncompaction cardiomyopathy suffering from ICD pulse generator pocket and lead infection with aggregatibacter actinomycetem comitans bacteremia. The complete device was successfully removed by a hybrid two-step approach using excimer laser and transfemoral lead extraction technique in combination with mechanical traction via the subclavian vein. Thereby, open surgery with possible need for cardiopulmonary bypass could be avoided in this patient.

A 55-year-old male was referred to the hospital due to exertional dyspnea, fatigue and pain in the ICD pulse generator pocket. ICD implantation was performed due to sustained ventricular tachycardia in isolated left ventricular noncompaction cardiomyopathy 10 years ago. ICD pulse generator was replaced due to battery depletion 3 years ago. On admission, the patient was hemodynamically stable, and the ICD pulse generator pocket was reddened and swollen. Laboratory chemistry revealed slightly elevated C-reactive protein levels (22 mg/l). No intracardiac vegetations were visualized by transesophageal echocardiography, left ventricular noncompaction was documented with a left ventricular ejection fraction of 51%. Coronary computed tomography revealed normal coronary arteries. The ICD pulse generator pocket was punctured and purulent material could be aspirated. Hence, diagnosis of …