Transvenous extraction of a 26-year-old Accufix atrial lead using TightRail rotating dilator sheath

With the increasing number of implanted pacemakers and implantable cardioverter defibrillators, removal is required more frequently. Presently described is the transvenous extraction of a 26-year-old Accufix atrial lead using a mechanical dilator sheath. A 50-year-old male patient was admitted to the clinic with a pacemaker pocket infection. The atrial lead was an Accufix Bipolar J-Atrial active fixation lead, a model that was recalled in 1994, after reports of 2 deaths and 2 nonfatal injuries related to protrusion of the J retention wire. Both the atrial and ventricular leads were extracted using a mechanical dilator sheath. The Pacemaker Lead Extraction with the Excimer Sheath (PLEXES) Trial reported that of the 57 Accufix leads randomized to a non-laser approach, only 47% were removed successfully, compared with 96% of laser-randomized cases. Since laser sheaths are not available in Turkey, use of a mechanical dilator sheath was required. To our knowledge, this is the oldest Accufix lead extracted with a non-laser sheath. During the extraction of the ventricular lead, the tip of the lead broke off inside the right ventricle and the residual part was left inside the heart. During 3 months of follow-up, no signs of infection or any other undesirable events were encountered.