title: Successful laser-assisted removal of an infected ICD lead with a large vegetation.
abstract: Infective endocarditis involving transvenous pacing leads is an uncommon but potentially lethal complication of implantable cardioverter-defibrillator (ICD) implantation. Complete removal of the device and the leads is presently considered to be the optimal treatment in such patients and laser-assisted lead removal is an effective and safe nonthoracotomy approach. However, large vegetations (>10 mm) attached to the lead limit nonthoracotomy explantation because of the potential for hemodynamically embarrassing pulmonary embolization. Laser extraction of leads with vegetation area >300 mm2 has rarely been reported. In this case report, we describe a patient with an infected ICD lead with vegetation greater than 41 x 12.5 mm (512 mm2) in size that was explanted with laser-assistance. The resulting pulmonary embolus produced a 33 x 20 mm pulmonary infarction without hemodynamic or respiratory compromise.
authors.affiliation: Division of Cardiology, University Health Network, Toronto, Canada.
authors.forename: Rajneesh
authors.initials: R
authors.lastname: Calton
authors.forename: Doulas
authors.initials: D
authors.lastname: Cameron
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cusimano
authors.forename: Naeem
authors.initials: N
authors.lastname: Merchant
authors.forename: Vijay
authors.initials: V
authors.lastname: Chauhan
mesh_terms: D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004696:Endocarditis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery*