HRCR Sep 2023 Quiz

Editorial note: The following quiz is related to the article “Femoral-superior lead extraction complicated by venous dissection in chronic venous occlusion: How the alligator saved the day, Frank Eberhardt and colleagues in the September 2023 issue of Heart Rhythm Case Reports.

What is the incidence of chronic venous stenosis or occlusion in patients with indwelling leads and a CIED?

0.5%
2.5%
Up to 30%
75%

The phlebography shown in supplementary video 1 (video still above) was obtained in a patient with a dual chamber pacemaker and a class I indication for an upgrade to a DDD-ICD system. Which statement is not correct?

This phlebography shows a total occlusion of the left subclavian vein. Thus, ipsilateral upgrade from DDD-pacemaker to DDD-ICD will not be feasible
Extraction of the ventricular pacing lead using a laser sheath or a rotational sheath to create a channel for the defibrillator lead might be a good treatment option in this situation
Alternatively, the left-sided pacemaker leads might be abandoned, the pacemaker removed and contralateral DDD-ICD implantation might be attempted
Passage of a hydrophilic wire with subsequent venoplasty is a good alternative option in this patient
Contralateral (right-sided) implantation of an ICD lead and tunneling of the lead to the left-sided pocket is also a treatment option

Which statement describes the correct class of recommendation for noninfectious lead extraction according to the HRS 2017 expert consensus statement?

Lead removal is a class III indication for patients with an SVC occlusion and the necessity to implant an additional lead
Lead removal is a class I indication if CIED implantation requires more than five leads through the SVC
Lead removal is a class IIa indication in patients with indwelling leads and a symptomatic SVC syndrome
Lead removal is a class IIa indication for patients with ipsilateral venous occlusion preventing access to the venous circulation for required placement of an additional lead

Which of the following tools should not be used in femoral lead extraction?

A Needle´s eye snare
A standard endoscopy alligator-forceps
A vena cava occlusion balloon in case of venous laceration
A coronary rotablator to facilitate recanalization of chronic venous occlusion from below
A goose neck snare in combination with a steerable EP catheter