489 A RARE CASE OF LEAD EXTRACTION

Abstract Aims Poor data exist about the leadless PM implantation through a bioprosthetic tricuspid valve. Bioprosthetic valve has traditionally represented relative contraindication to transvenous right ventricular pacing for possible damage and dysfunction. Therefore, epicardial is usually preferred deleterious effect of permanent leads on function regurgitation. Methods Our case focuses 62-year-old woman with mechanical mitral biological prosthesis due rheumatic disease since 2007 PM-DDDR postsurgical complete atrioventricular block. A lead was implanted in atrium while another coronary sinus (CS) instead ventricle following presence prosthesis. In February 2022, she did replacement pacemaker (PM) generator hospital initial battery depletion. March described pain at device pocket consequent appearance infection. For this situation admitted our cardiac department. transesophageal echocardiography (TEE) performed showed normal biventricular size (LVEF 55%), prostheses absence vegetations both valves atrial lead. Subsequently an angiography revealed little patency anonymous-caval-subclavian left axis. We made diagnosis infection decided extract March. proceded debridement removal generator. After placing Spectranetics (Philips) Lead Locking Device n.2 (LLD2) along lead, we removed it use extractors (Cook 7-8.5 Fr). Then after (Philips)Lead E (LLDE), CS completely Fr) specific delivery.The procedure well tolerated uneventful. Following negative result post-extraction blood cultures, cultures tips swab, together normalization inflammation indices (WBC CRP) end antibiotic therapy, reimplant device.For patient's high infectious risk, implant PM. Results At beginning April Micra AV 23-F TPS delivery catheter across apex middle septum difficulties concomitant The uneventful too. She discharged 72h good conditions. Conclusions present unusual extraction second patient Leadless represents new technology by eliminating risks connected