In this article, the authors provide an updated overview on successful lead extraction methods for pacemaker and defibrillator cases.

Permanent pacemakers and automatic internal cardioverter defibrillators (AICDs) have been improving and saving lives for over 50 years.1 Unfortunately, in rare cases these devices can pose potential harm to a patient, thus indicating removal. Removal or replacement of the generator only does not pose as much risk as lead extraction. Abandoning or disabling malfunctioning leads will suffice in the majority of patients who no longer have an indication or desire for continued therapy. However, lead extraction is indicated when malfunction results in potential harm, when there is difficulty clearing a blood stream infection, when venous stenosis has ensued, or when procedures, normally contraindicated with implanted devices, are necessary.2

Dear Readers,
Transseptal puncture (TSP) was first described independently by Ross and Cope in 1959. Prior to this, the left atrium was accessed via a transbronchial or direct percutaneous infrascapular approach. Initially, transseptal left atrial access was used to assess hemodynamics and perform mitral valvuloplasty, and most of the expertise related to transseptal catheterization resided in the hands of interventional cardiologists. Many electrophysiologists did not have the training needed to perform TSP. In fact, in many EP labs, left-sided accessory pathways were ablated primarily using a retrograde aortic approach; in the rare cases, when transseptal catheterization was required, an interventional cardiologist was often summoned to help.

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Under Discussion:

Cable Disorganization
Our lab has an abundance of cables that often becomes tangled and inevitably damaged. Last week, damaged cable resulted in an intraprocedure delay of over 1 hour. Our Biomedical Engineers have authorized our department to contact a third-party vendor for consultation. Has anyone had similar issues, and if so, how did you correct the problem? Does anyone know of a vendor that services this type of problem?
— anonymous
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Try SystemsOne, LLC. They offer a big screen, but are also about organizing the cables to reduce wear and tear as well as reduce electrical noise.
— anonymous

Also Under Discussion:

It is now well established that the implantable cardioverter defibrillator (ICD) is an accepted means of primary and secondary prevention in those patients who are at increased risk of sudden cardiac death, arrhythmias such as Brugada syndrome, and conditions due to primary cardiomyopathies and heart failure. The data supports increased survival rates and better quality of life (QOL) by improving the ability to participate in normal daily activities and exercise programs. However, because the implantation often occurs against a complex medical background with inevitable psychological stress, all implanted patients should be considered at high risk for developing psychopathology.1