Excimer laser lead extraction by femoral approach.

Despite the latest improvements in pacemaker/defibrillator lead extraction techniques, this procedure may be hindered by specific problems related to patient/lead characteristics. We report the case of a 67-year-old man with a single-chamber implantable defibrillator (ICD) with a malfunctioning right ventricular (RV) defibrillating lead, referred for lead extraction. During extraction of the defibrillating electrode, the added sensing/pacing RV lead suddenly manifested an inapparent fracture with migration within the superior vena cava. Lead extraction through a superior conventional and laser-assisted approach was ineffective. The use of the laser sheath through the femoral approach allowed complete removal of the migrated lead and reimplantation of a new ICD lead