P997First experience in 19 months attain stability lv-lead extraction

Background: Two main issues in CRT are:1) obtain constant LV capture without PNS or lead dislodgment and 2) managing CIED infections. Active fixation LV lead Medtronic 20066 Attain Stability allows lead fixation in the target CS vein but there are no long term extraction success data. We report our experience in extraction of this lead, 19 months after implantation. Clinical Case: 84 y.o. man affected by chronic ischemic cardiopaty with severe left ventricular dysfunction (LVEF 25%) and left bundle branch block (native QRS: 180 msec). Implanted with CRT-D (2012) and undergone to malfunctioning LV-lead extraction and reimplantation with a Medtronic 20066 Attain Stability active fixation LV lead (February 2015), he was admitted in our facility in September 2016 diagnosed with pocket infection after complete laboratory and imaging assessment. Patient underwent to CRT-D explant and lead extraction procedure. We performed manual technique using 10-11F mechanical dilator sheats for passive fixation atrial lead and ventricular dual coil active fixation lead. LV lead was armed with non-autolocking stylet, disanchored with just 4 counterclockwise rotations and simply retrieved with manual traction. Procedure was well tolerated without any complication. After 21 days of targeted anthibiotic therapy, patient was right-sided reimplanted with CRT-D and a new Attain Stability Lead in the same PL branch of CS of former one. Conclusions: in our experience, Medtronic Attain Stability active fixation LV lead showed to be safely and effectively extracted, aven 19 months after implantation, as never reported before in literature.