Figures
Figure 1. 2-view chest X-ray and electrocardiogram of the
patient prior to the procedure. (A) Chest X-ray shows the
severed epicardial leads. There are 2 bipolar atrial and 2 ventricular
screw leads in place. There is mild cardiomegaly, trace right and small
left pleural effusion. Postsurgical changes of median sternotomy wires.(B) electrocardiogram shows atrial fibrillation with normal
ventricular response, right axis deviation and non-specific ST-T wave
changes. (C) Example of the CapSure epicardial leads. CapSure
epicardial leads, have a lead body that is coaxial bipolar in
construction, however it bifurcates into what are essentially two
unipolar electrodes that are individually attached to the myocardium
(Figure C source: Medtronic Academy website. Reproduced with permission
from Medtronic).
Figure 2. Snapshots during the procedure. (A) Surgical
exposure of the two severed epicardial atrial bipolar leads. One 0-silk
suture was used to secure the tip of each lead. (B) The atrial
lead has been cut and prepared to be inserted in the IS-1 lead extender.
Only the anode was retrieved in this preparation. (C) Surgical
adhesive glue used to seal off the ends of the lead extender / lead
assembly. (D) The lead extender / lead assembly is completed
and ready to be connected to the generator. (E) The Oscor,
BIS/BIS, quadrifilar, silicone-covered, lead extender with the bipolar
receptacle and bipolar connector, as well as the set screws annotated.
Figure 3. 2-view chest X-ray and electrocardiogram of the
patient after the lead salvage procedure. (A) Chest X-ray shows
a single-chamber pacemaker implanted at the right upper quadrant. The
pacemaker is connected to one of the atrial epicardial leads via the
BIS/BIS lead extender (red arrow). The other leads remain in same
position. No visible pneumothorax. Minimal bilateral pleural effusions,
mild cardiomegaly, postsurgical changes of median sternotomy wires,
unchanged from the pre-procedure films. (B) electrocardiogram
shows atrial pacing with consistent atrial capture and intact
atrioventricular conduction, right axis deviation and non-specific ST-T
wave changes.