Recommended Citation
Warren B, Ebrahimi F. ICD removal complicated by right ventricle injury in a patient with hypertrophic obstructive cardiomyopathy. Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Abstract
Introduction: Lead extraction is an essential component of cardiovascular implantable electronic device (CIED) management, particularly as the number of implanted devices continues to rise. While over 500,000 implantable cardioverter-defibrillators (ICDs) have been implanted in the U.S. since 2010, lead extractions remain relatively infrequent, with an estimated 10,000 to 15,000 procedures performed annually worldwide. Complications, though rare, can be life-threatening. Case Presentation: A 76-year-old male with a history of hypertrophic obstructive cardiomyopathy (HOCM), non-sustained ventricular tachycardia, paroxysmal atrial fibrillation (s/p Watchman device and cryoablation), and multiple comorbidities underwent an ICD lead extraction for a malfunctioning right ventricular (RV) dual-coil lead. Initial attempts at retrieval via the left subclavian and right femoral vein approaches were unsuccessful. A right internal jugular vein approach was then used, employing bronchial biopsy forceps under fluoroscopic guidance. During lead retrieval, the patient experienced cardiac arrest, requiring immediate chest compressions. Transesophageal echocardiography (TEE) revealed pericardial effusion with tamponade, necessitating pericardiocentesis. Despite drainage, tamponade recurred, prompting placement of a parasternal pigtail catheter. The patient required massive transfusion and escalating vasopressor support. Surgical exploration identified right ventricular and vascular injuries at the innominate vein-superior vena cava (SVC) junction, which were repaired under cardiopulmonary bypass. Postoperatively, the patient developed refractory coagulopathy and succumbed to multi-system failure the following morning. Conclusion: ICD lead extraction carries significant risks, including ventricular rupture, valvular injury, tamponade, and massive hemorrhage. This case highlights the importance of vigilance, preparedness for major complications, and the challenges posed by underlying cardiac pathology such as HOCM in managing tamponade. Multidisciplinary coordination is crucial in optimizing outcomes for high-risk patients undergoing lead extraction procedures. Nitesh Sood, et al. (2018) Circ Arrhythm Electrophysiol 11(2):e004768.
Type
Oral/Podium Presentation
Affiliations
Advocate Illinois Masonic Medical Center