Free-Floating Leads

When removing free-floating leads (see Chapter 10). 

In the presence of adherences located in the coronary sinus or right ventricular outflow tract (also described in Chapter 10). 

After lead extraction for a noninfective indication, I reimplant a new pacing or ICD system. Details for reimplantation are described in Chapter 9. A check for bleeding is essential to prevent hematoma, and appropriate care of the pocket is essential to prevent recurrent infection. In the majority of infected pocket, extensive debridemen-tand sutures are required, following the rules and techniques of plastic surgery. If the pocket is infected, I place a small drain to prevent hematoma formation, which may lead to reinfection. In many patients with infective indications, the procedural time for lead preparation, closure, and suture is greater than for lead extraction. 

Seventy-eight free-floating leads were approached via the femoral vein. Grasping the lead allowed 

Thrombosis or venous stenosis Class I (level of evidence C) 45 

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The transfemoral approach is adopted in many centers as a primary approach when free-floating leads are involved and as an alternative approach in case of failed primary approach through the implant vein [23, 43-45]. Some techniques using the transfemoral approach allow grasping and removal of exposed or intravascular leads, fragments of... 

Whereas free-floating leads with detached tips... 

We use the internal transjugular approach (Fig. 4.28) as a first choice for free-floating leads and as an additional step for difficult leads when mechanical dilatation is ineffective or risky [8, 46]. In the presence of free-floating leads, this approach results in... 

The internal jugular venous approach is used as (1) a first choice in the presence of free-floating leads with attached tip (2) in case of an unsuccessful approach from the venous entry site. 

Changing an exposed into free-floating lead is more common. Most of these leads are malfunctioning or infected at the time of abandonment. 

Free-floating leads Venous entry site approach impossible for unexposed intravasculai leads Binding-site dilatation with the transfemoral workstation is often ineffective particularly in the venti icle Tmnsjugular approach... 

In the presence of free-floating leads, the first issue is how to grasp the lead. The key points in these cases are fragment length, position, and binding sites to the vascular and/or cardiac walls. For the purpose of transvenous extraction, the... 

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