title: Solvent-facilitated lead disconnection for battery replacement in patients with pacemakers or implantable cardioverter defibrillators.
abstract: OBJECTIVE
  Battery exchange in pacemaker (PM) or implantable cardioverter defibrillator (ICD) devices may be occasionally problematic because of difficulties in lead disconnection procedures and risk of injuring the fragile leads. This pilot study compares ethanol and dimethyl sulfoxide (DMSO) as solvents to assist removal of leads from PM or ICD device headers in cases of stuck leads or difficulties in untightening device header screws.
  
  
  RESULTS
  Of the total number (527) of our patients requiring battery replacement due to end-of-life (EOL) warnings, conventional exchange was not possible in 34 (6.5%) due to embedding of the lead within blood-derived material. Of these, 30 (17 with PM, 13 with ICD) consented to the study and were randomly assigned to a primary attempt at lead disconnection by ethanol (n = 17) or by DMSO (n = 13). If the primary attempt failed, a secondary attempt at lead disconnection was undertaken using the alternate solvent. Ethanol was a superior solvent compared with DMSO, yielding successful disconnection at primary attempt in 88.2% (15/17) vs. 23.1% (3/13) of cases. In 8 patients in whom the primary DMSO-attempted disconnection failed, a secondary attempt with ethanol yielded success in 6 (75%) cases. Use of either ethanol or DMSO in lead disconnection was not associated with any adverse events or effects.
  
  
  CONCLUSIONS
  Ethanol has utility as a simple and inexpensive modality for lead disconnection from ICD or PM headers.
authors.affiliation: Laboratory of Signal Transduction, Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, Basel CH 4031, Switzerland paul.erne@erne-net.ch.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.affiliation: Department of Cardiology, Luzerner Kantonsspital, Luzern 16 6000, Switzerland.
authors.forename: Richard
authors.initials: R
authors.lastname: Kobza
authors.affiliation: Biotronik Schweiz AG, Neuhofstrasse 4, Baar 6341, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Lehner
authors.affiliation: Laboratory of Signal Transduction, Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, Basel CH 4031, Switzerland.
authors.forename: Therese J
authors.initials: TJ
authors.lastname: Resink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000379:methods*; D004121:Dimethyl Sulfoxide / Q000737:chemistry*; D000431:Ethanol / Q000737:chemistry*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010865:Pilot Projects; D012997:Solvents / Q000737:chemistry
chemical_list: D012997:Solvents; D000431:Ethanol; D004121:Dimethyl Sulfoxide
keywords: Device battery replacement; Dimethyl sulfoxide; Ethanol; Lead disconnection