Coronary Sinus

We report a difficult coronary sinus lead extraction, which required both superior (subclavian) and inferior (femoral) approaches and the use of multiple lead extraction tools. Although the lead was not infected, extracting this coronary sinus lead still has a Class I indication according to the Heart Rhythm Society (HRS) expert consensus on transvenous lead extractions. This is because the coronary sinus failing lead with its high pacing threshold interfered with the function of the CRT-D device leading to early battery drainage. Moreover, it would have been impossible to implant a new coronary sinus lead while leaving the old one in place due to the coronary sinus ostium adhesions and the difficulty in manoeuvring the new lead into the lateral branch.