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European perspective on lead extraction: Part II

Published:September 21, 2007DOI:https://doi.org/10.1016/j.hrthm.2007.09.014
      If manual extraction is not successful, a locking stylet is used after the inner lumen is reamed using another stylet to remove debris. Use of a locking stylet with a very flexible tip is essential so that a tortuous lead can be negotiated. Equally important is locking the stylet as close as possible to the lead tip and not allowing the stylet to slip during the procedure. The risk of severing the sometimes fragile interpolar section of encapsulated bipolar leads is high if a positive lock close to the lead tip cannot be achieved. To avoid pulling out the core of the lead and leaving the outer insulation in place, a ligature is used to fasten the insulation to the rest of the lead and to the locking stylet. I recommend using a large-diameter ligature and distributing the tension using at least two separate knots to avoid cutting the insulation with the ligature (Figure 1). A long ligature (reeled) is used to avoid obstructing knots inside sheaths.
      Figure thumbnail gr1
      Figure 1Leads ready for extraction with locking stylets inserted and insulation sutures attached.

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      References

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        Hands on: lead extraction using the femoral vein.
        Heart Rhythm. 2007; 8: 1102-1111
        • Bongiorni M.G.
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        Transvenous removal of difficult pacing and ICD leads; a new technique through the internal jugular vein.
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