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  • Title: Successful laser-assisted removal of an infected ICD lead with a large vegetation.
    Author: Calton R, Cameron D, Cusimano RJ, Merchant N, Chauhan V.
    Journal: Pacing Clin Electrophysiol; 2006 Aug; 29(8):910-3. PubMed ID: 16923010.
    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.
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