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 52 y/o M 84 y/o M 74 yo M ICM EF 10 -15% ICM EF 25% ICD implant 2006 ICD implant 2007 Bi. V ICD 2006, Hx SCD Leads: 4076, 6949 Leads: 4076, 4194, 6949 NYHA III with new LBBB NYHA Class III, Chronic AF, CKD (Creat 2. 6) Referral for upgrade to Recurrent ICD therapy appropriate AV nodal Ablation Bi. V-ICD Fidelis lead fracture Referral for ERI
Factors in Decision Making • Patient’s age at implant • Lead age • Fracture location • Pacing dependency • Therapy dependency • Co-morbidities • Patient Anxieties • Type of Lead • Location of Lead
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 Bi. V-ICD Leave Fidelis & No new Lead Leave Fidelis & Implant New ICD lead Abandon Leads & Implant contralateral Extract Fidelis & Implant New ICD lead
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 Bi. V-ICD Leave Fidelis & No new Lead Leave Fidelis & Implant New ICD lead Abandon Leads & Implant contralateral Extract Fidelis & Implant New ICD lead
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
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
Case 3: Patient’s Options 74 yo M ICM EF 25% Bi. V 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
Case 3: Patient’s Options 74 yo M ICM EF 25% Bi. V 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
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