TY - JOUR
T1 - Lead stuck (frozen) in header
T2 - Salvage by bone cutter versus other techniques
AU - Fisher, John D.
AU - Lapman, Peter
AU - Kim, Soo G.
AU - Ferrick, Kevin J.
AU - Gross, Jay N.
AU - Palma, Eugen C.
AU - Delvecchio, Alexander
PY - 2004/8
Y1 - 2004/8
N2 - It is occasionally difficult to disconnect leads from headers at the time of pulse generator replacement without injuring the fragile leads. Over a 2.5-year period we encountered this problem in six cases (1.7% of pulse generator replacements). The posterior portion of the header was clipped off using an orthopedic bone cutter in four cases. The cut was aligned with the deep end of the lead socket in the header. A metal rod was then used to push the lead out of the socket. Bench testing of alternative methods was done on previously explanted pulse generators that were firmly held in a vice. Motorized microtools were used to drill holes from the end of the header to the deep end of the socket; or with a rotary saw attachment to slice off the back of the header, allowing a retained lead to be pushed out. The latter was also done with a hand held razor saw, and attempts were made with a scalpel. Lead removal in the clinical cases was accomplished quickly in the four cases using the bone-cutter, without trauma to the lead. Bench testing results varied. The bone cutter was the most efficient method for most brands, but was ineffective on one. The motorized tool was difficult to position, produced sprays of plastic particles, and would have been risky in a clinical setting. The razor saw was difficult to use safely, or efficiently, except in some headers that resisted the bone cutter. The scalpel failed except in one "soft header" pacemaker. An orthopedic bone cutter is a useful tool for removing a retained lead from a pulse generator header. Different header designs and materials necessitate knowledge of several lead detachment methods.
AB - It is occasionally difficult to disconnect leads from headers at the time of pulse generator replacement without injuring the fragile leads. Over a 2.5-year period we encountered this problem in six cases (1.7% of pulse generator replacements). The posterior portion of the header was clipped off using an orthopedic bone cutter in four cases. The cut was aligned with the deep end of the lead socket in the header. A metal rod was then used to push the lead out of the socket. Bench testing of alternative methods was done on previously explanted pulse generators that were firmly held in a vice. Motorized microtools were used to drill holes from the end of the header to the deep end of the socket; or with a rotary saw attachment to slice off the back of the header, allowing a retained lead to be pushed out. The latter was also done with a hand held razor saw, and attempts were made with a scalpel. Lead removal in the clinical cases was accomplished quickly in the four cases using the bone-cutter, without trauma to the lead. Bench testing results varied. The bone cutter was the most efficient method for most brands, but was ineffective on one. The motorized tool was difficult to position, produced sprays of plastic particles, and would have been risky in a clinical setting. The razor saw was difficult to use safely, or efficiently, except in some headers that resisted the bone cutter. The scalpel failed except in one "soft header" pacemaker. An orthopedic bone cutter is a useful tool for removing a retained lead from a pulse generator header. Different header designs and materials necessitate knowledge of several lead detachment methods.
KW - Complications of ICD implants
KW - Complications of pacemaker implants
KW - Frozen leads
KW - Pulse generator implants
KW - Retained leads
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U2 - 10.1111/j.1540-8159.2004.00596.x
DO - 10.1111/j.1540-8159.2004.00596.x
M3 - Article
C2 - 15305964
AN - SCOPUS:4344695012
SN - 0147-8389
VL - 27
SP - 1136
EP - 1143
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
IS - 8
ER -