Removal of subcutaneous defibrillator shocking coils: Lessons to learn for future extraction of subcutaneous defibrillator systems.

BACKGROUND: Subcutaneous shocking coils (SQC) have been used to lower defibrillation thresholds in certain patient populations. There are limited data regarding the extraction complexity of these leads. The goal of this study is to describe our SQC extraction experience and identify challenges that may be of importance with the increase in utilization and extraction of fully subcutaneous defibrillator systems. METHODS: We studied consecutive patients who underwent lead removal at our institution during which a Medtronic 6996SQ (Medtronic plc, Minneapolis, MN, USA) was removed RESULTS: Twenty-one patients (54.5 ± 14 years, 85.7% male) underwent procedures where at least one lead removed was a SQC. Mean ejection fraction was 27.7% and 11 patients had prior ventricular arrhythmia. Median SQC age was 177 days and the age of the oldest SQC removed was 3,041 days. Infection was the indication for removal in 14 patients. One removal was performed surgically and 20 were completed percutaneously. Three procedures required additional incisions beyond the device pocket and tie-down sleeve to complete the SQC lead removal due to dense adhesions. One removal procedure required the use of a laser sheath to relieve fibrosis. Complications in this group did not appear related to SQC removal. CONCLUSIONS: Drawing from our SQC removal experience, there may be a need for additional incisions and extra tools to complete removal of older subcutaneous implantable cardioverter defibrillator leads.