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
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