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.