Use of a cerebral protection device for the laser extraction of a pacemaker lead traversing a patent foramen ovale

Introduction 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 (Heart Rhythm Society, 2009) do not recommend routine percutaneous lead extraction in asymptomatic patients (class IIIC indication), extraction canbe 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.