Percutaneous extraction of a 20-year-old Accufix pacemaker lead complicated by intraoperative protrusion of its J retention wire

Case report A 75-year-old man presented with recurrent persistent Staphylococcus bacteremia from spinal osteomyelitis. He had a past medical history significant for complete heart block for which a pacemaker with an Accufix ventricular lead (model number 330-258) was placed in 1990 and then an Accufix right atrial (RA) lead (model unavailable) in 1995. The bacteremia persisted despite intravenous antibiotic treatment; therefore, to clear bacteremia, percutaneous removal of his pacemaker system was recommended. In a hybrid operating room under general anesthesia the leads were dissected free from the subcutaneous adhesions and transected, and then locking stylets were passed down the inner lumen of each lead. A 14 F laser sheath (Spectranetics, Colorado Springs, CO) was passed over the atrial lead and laser energy was applied as needed, but because significant resistance was encountered at the superior vena cava and RA junction, it was upsized to a 16 F laser sheath. Again resistance was encountered at this junction, and significant binding between the RA and right ventricular (RV) leads was observed. The laser sheath was then placed