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Interactive Case Studies in Lead Extraction

Interactive Case Studies in Lead Extraction. John Andriulli, DO, FACC Assistant Professor of Medicine Director of Arrhythmia Device Program Cooper University Hospital. CASE 1. CASE 2. CASE 3. 84 y/o M ICM EF 25% ICD implant 2007 Leads: 4076, 4194, 6949

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Interactive Case Studies in Lead Extraction

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  1. Interactive Case Studiesin Lead Extraction John Andriulli, DO, FACC Assistant Professor of Medicine Director of Arrhythmia Device Program Cooper University Hospital

  2. CASE 1 CASE 2 CASE 3 84 y/o M ICM EF 25% ICD implant 2007 Leads: 4076, 4194, 6949 NYHA Class III, Chronic AF, CKD (Creat 2.6) AV nodal Ablation Fidelis lead fracture 74 yo M ICM EF 25% BiV ICD 2006, Hx SCD Leads: 4076, 4194, 6949 Recurrent ICD therapy appropriate Referral for ERI 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

  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

  4. Case 1: Patient’s Options 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 Leave Fidelis & Implant New ICD lead Abandon Leads & Implant contralateral Extract Fidelis & Implant New ICD lead

  5. Case 1: Patient’s Options 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 Leave Fidelis & Implant New ICD lead Abandon Leads & Implant contralateral Extract Fidelis & Implant New ICD lead

  6. Case 2: Patient’s Options 84 y/o M ICM EF 25% ICD implant 2007 Leads: 4076, 4194, 6949 NYHA Class III, Chronic AF, CKD (Creat 2.6) AV nodal Ablation Fidelis lead fracture Leave Fidelis & No new Lead Cap Fidelis & Implant New ICD lead Cap Leads & Implant contralateral Extract Fidelis & Implant New ICD lead Cap Fidelis & Implant P-S Lead

  7. Case 2: Patient’s Options 84 y/o M ICM EF 25% ICD implant 2007 Leads: 4076, 4194, 6949 NYHA Class III, Chronic AF, CKD (Creat 2.6) AV nodal Ablation Fidelis lead fracture Leave Fidelis & No new Lead Cap Fidelis & Implant New ICD lead Cap Leads & Implant contralateral Extract Fidelis & Implant New ICD lead Cap Fidelis & Implant P-S Lead

  8. Case 3: Patient’s Options 74 yo M ICM EF 25% BiV ICD 2006, Hx SCD Leads: 4076, 4194, 6949 Recurrent ICD therapy appropriate Referral for ERI Leave Fidelis & No new Lead Cap Fidelis & Implant New ICD lead Cap Leads & Implant contralateral Extract Fidelis & Implant New ICD lead

  9. Case 3: Patient’s Options 74 yo M ICM EF 25% BiV ICD 2006, Hx SCD Leads: 4076, 4194, 6949 Recurrent ICD therapy appropriate Referral for ERI Leave Fidelis & No new Lead Cap Fidelis & Implant New ICD lead Cap Leads & Implant contralateral Extract Fidelis & Implant New ICD lead

  10. 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

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