Use of a cerebral protection device for the laser extraction
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Inadvertent positioning of a pacing lead in the left atrium (LA) or left ventricle (LV) is a rare but well-recognized complication of pacemaker or defibrillator implantation. Traditional management involves systemic anticoagulation to reduce the risk of thromboembolic complications. Although international consensus guidelines do not recommend routine percutaneous lead extraction in asymptomatic patients (class IIIC indication), extraction can be considered “if the clinical scenario is compelling.” Lead extraction from the LA carries a risk of cerebral embolism, and therefore techniques to reduce this risk may be of clinical benefit.

A woman underwent dual-chamber implantable cardioverter-defibrillator implantation for long QT syndrome 1 and recurrent syncope at the age of 36. At her second generator change 13 years later, a new atrial lead was implanted owing to failure of the original lead. It was difficult to find an atrial site with satisfactory parameters, but eventually a suitable location was achieved...

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