To replace or to abandon and implant a new lead? Conservative approach creates new challenges (and risks) for the patients in future. Should we still wait for class 1 indications ? Case report and discussion of the problem.
Paweł Stefańczyk 1  
,  
Wojciech Borzęcki 1  
,  
Łukasz Tułecki 2  
,  
Konrad Tomków 2  
,  
Dorota Nowosielecka 1  
,  
Andrzej Kleinrok 1  
,  
 
 
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1
Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Poland (1)
2
Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc Poland (2)
3
Department of Cardiology Medical University of Lublin, Poland (3)
CORRESPONDING AUTHOR
Paweł Stefańczyk   

Department of Cardiology The Pope John Paul II Province Hospital of Zamosc Poland (1)
Publish date: 2019-08-09
 
Heart Beat 2019;4:16–19
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ABSTRACT
Background:
The ideal situation for patients is to have as many active and properly placed leads as necessary. We report the case of a 69-year-old woman with multiple indications for lead extractions existing for 9 years but having class 2b. Doctors preferred a conservative option of dealing with numerous problems unnecessarily ignoring long lead loops and deciding to implant additional lead. After 9 years the removal of the whole hardware was indispensable in order to implant the new one CRT-D pacing system. The performed TLE procedure was difficult due to several complex technical problems but finally successful regardless the complete venous occlusion. The TLE performed 9 years earlier would be much safer, easier and less dramatic. The conclusion is that it is much more advisable to perform the TLE immediately as regards patients with long life prognosis than to prolong it. Furthermore, the conservative option of management lead related problems creates multiple obstacles in the future.

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