Laser lead extraction for patient suffering with Automated Implantable Cardioverter-Defibrillator (AICD) infection and subsequent implantation of new system as subcutaneous AICD (S-ICD) at cardiac catheterization lab, Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital

Abstract

Patient whom sustained cardiac arrest from ventricular arrhythmia such as ventricular tachycardia or ventricular fibrillation required immediate treatment with defibrillation to save life. During defibrillation by external defibrillator, heart will receive electrical energy to convert disorganize rhythm into organize rhythm therefore heart could become beating again. According to 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary⁽⁵⁾ , automated implantable cardioverted defibrillator (AICD) implantation is being performed on selected patients as primary or secondary prevention for sudden cardiac death. General concept of AICD implantation is to have AICD battery or generator place underneath skin  at pre-pectoral space but in rare occasions it is placed underneath muscle layer. AICD lead is placed through venous access and fixed to patient’s heart. Overall complications following this procedure reported to be less than 5% from local data⁽¹⁾ including bleeding and infection. Infection of AICD system is considered a serious complication which required explantation of the device to mitigate risk of infective endocarditis. During explantation, lead extraction maybe challenging due to lead adhesion which can be overcome by using laser lead extraction system (class I indication according to 2018 EHRA expert consensus statement on lead extraction)^(3,4). After removal of infected AICD system and elimination of infection is ensured, new AICD system will be re-implanted. In some selected patients may be suitable for subcutaneous implantable cardioverter defibrillator (S-ICD) . S-ICD has entire system placed subcutaneously therefore, this would help reduce risk of infective endocarditis as no venous access required.