# Extraction and Reimplantation of a Subcutaneous Implantable Cardioverter Defibrillator: Two Cases and a Review of the Literature

## TL;DR

This paper discusses the safe extraction and reimplantation of subcutaneous implantable cardioverter defibrillators, highlighting two cases and reviewing the literature.

## Contribution

The paper presents two clinical cases and a literature review on managing subcutaneous defibrillator complications.

## Key findings

- Lead extraction techniques for subcutaneous defibrillators are straightforward and have low complication rates.
- Infection and lead dysfunction are key reasons for lead extraction in subcutaneous defibrillators.
- Expertise in cardiac pacing is essential for successful lead extraction and reimplantation.

## Abstract

For several years, implantable cardioverter defibrillators (ICDs) have been the cornerstone for the prevention of sudden cardiac death. However, the weakness of traditional transvenous ICD systems lies in the intravascular lead, which is prone to issues such as conductor fracture, insulation abrasion, risk of dislodgement, and infection. With the new generation of subcutaneous defibrillators, these risks are far less common. To date, the frequency of lead fracture is very low, and infection is much rarer. The management of these complications requires complete lead extraction. Traction is the reference procedure, sometimes necessitating the use of a dilating sheath. These techniques remain straightforward to perform without significant risk of procedural complications. Nevertheless, they must be carried out by an expert in cardiac pacing. We report here two cases with indications for lead extraction: one for lead dysfunction and the other for an infection related to a replacement procedure. The management approaches will be described, followed by a review of the literature.