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Transvenous lead extraction, epicardial lead implantation and simultaneous left atrial appendage closure in a patient with left-sided superior vena cava and systemic device-related endocarditis
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  • Simon Pecha,
  • Johannes Petersen,
  • Yalin Yildirim,
  • Paulus Kirchhof,
  • Hermann Reichenspurner,
  • Tobias Tönnis
Simon Pecha
University Heart Center Hamburg

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Johannes Petersen
University Heart Center Hamburg
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Yalin Yildirim
University Heart Center
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Paulus Kirchhof
University Medical Center Hamburg-Eppendorf
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Hermann Reichenspurner
University Heart Center
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Tobias Tönnis
University Heart and Vascular Center Hamburg
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Abstract

A 78-year old male patient with a left-sided superior vena cava presented with systemic device infection and atrial fibrillation. Transvenous lead extraction was successfully performed. Due to a previously difficult endovascular left-ventricular (LV) lead implantation and pacemaker dependency, an epicardial LV-lead was implanted via minimally-invasive left-lateral thoracotomy. Simultaneously, due to AF, left-atrial appendage closure using an epicardial clip was performed through the same access. The patient was discharged with a wearable defibrillator and scheduled for a CRT-D upgrade eight weeks later. An implantation of new transvenous RV- and RA lead was performed and the existing left-ventricular epicardial lead was used.