Interactive Case Studies in Lead Extraction
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Interactive Case Studies in Lead Extraction John Andriulli, DO, FACC Assistant Professor of Medicine Director of Arrhythmia Device Program Cooper University Hospital
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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 - PowerPoint PPT Presentation
Transcript of Interactive Case Studies in Lead Extraction
Interactive Case Studiesin Lead Extraction
John Andriulli, DO, FACCAssistant Professor of Medicine
Director of Arrhythmia Device ProgramCooper University Hospital
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
CASE 184 y/o M
ICM EF 25%
ICD implant 2007
Leads: 4076, 4194, 6949NYHA Class III, Chronic AF, CKD (Creat 2.6)
AV nodal Ablation
Fidelis lead fracture
CASE 2
74 yo M
ICM EF 25%
BiV ICD 2006, Hx SCDLeads: 4076, 4194, 6949
Recurrent ICD therapy appropriate
Referral for ERI
CASE 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
Leave Fidelis & No new Lead
Case 1: Patient’s Options
Leave Fidelis & Implant New ICD lead
Extract Fidelis & Implant New ICD lead
Abandon Leads & Implant contralateral
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
Case 1: Patient’s Options
Leave Fidelis & Implant New ICD lead
Extract Fidelis & Implant New ICD lead
Abandon Leads & Implant contralateral
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
Case 2: Patient’s Options
Cap Fidelis & Implant New ICD lead
Extract Fidelis & Implant New ICD lead
Cap Leads & Implant contralateral
Cap Fidelis & Implant P-S Lead
84 y/o M
ICM EF 25%
ICD implant 2007
Leads: 4076, 4194, 6949NYHA Class III, Chronic AF, CKD (Creat 2.6)
AV nodal Ablation
Fidelis lead fracture
Leave Fidelis & No new LeadCase 2: Patient’s Options
Cap Fidelis & Implant New ICD lead
Extract Fidelis & Implant New ICD lead
Cap Leads & Implant contralateral
Cap Fidelis & Implant P-S Lead
84 y/o M
ICM EF 25%
ICD implant 2007
Leads: 4076, 4194, 6949NYHA Class III, Chronic AF, CKD (Creat 2.6)
AV nodal Ablation
Fidelis lead fracture
Leave Fidelis & No new Lead
Case 3: Patient’s Options
Cap Fidelis & Implant New ICD lead
Extract Fidelis & Implant New ICD lead
Cap Leads & Implant contralateral
74 yo M
ICM EF 25%
BiV ICD 2006, Hx SCDLeads: 4076, 4194, 6949
Recurrent ICD therapy appropriate
Referral for ERI
Leave Fidelis & No new Lead
Case 3: Patient’s Options
Cap Fidelis & Implant New ICD lead
Extract Fidelis & Implant New ICD lead
Cap Leads & Implant contralateral
74 yo M
ICM EF 25%
BiV ICD 2006, Hx SCDLeads: 4076, 4194, 6949
Recurrent ICD therapy appropriate
Referral for ERI
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
