Johnny Silva Cancer Research

Accufix Wire Fragment Retrieval

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As noted previously, fracture of the "J" retention wire in the Accufix family of atrial leads may produce protrusion of a wire fragment (Fig. 5.23), which has the potential to lacerate the heart and other mediastinal structures. It may be possible to selectively retrieve the protruding fragment if it is the distal portion of the proximal part of the wire. This is achieved using an Amplatz gooseneck snare passed through an 8F coronary guide catheter of a shape matching the specifics of the case. Since the proximal portion of the retention wire lies free under the outer insulation of the lead, traction on its protruding end results in the fragment's removal from the lead into the guide catheter without disrupting the lead itself. Detection of a protruding fragment (so-called class III fracture) by screening fluoroscopy should prompt consideration of this form of therapy as an option to lead extraction.80

Figure 5.23. Cinefluoroscopy of the Telectronics Pacing Systems model 330-801 Accufix atrial J lead. This right anterior oblique projection shows the protruding segment of the retention wire fragment (arrow).