Conductor externalization of the RIATA implantable cardioverter defibrillator lead: a challenging lead extraction requiring laser-powered sheath

We report the case of a 27-year-old man who received a single chamber implantable cardioverter defibrillator with a St Jude Medical Riata double coil passive lead for secondary prevention of sudden cardiac death due to idiopathic ventricular fibrillation. Subsequently, he was readmitted for lead extraction because of device infection. Fluoroscopy showed externalization of the conductors proximally to the distal coil in the absence of any signs of electrical lead failure. Successful lead extraction was achieved using a laser sheath without any complications after unsuccessful mechanical sheath because of the tenacious fibrotic adherences proximal to the distal coil and extrusion of the conductors that hindered the advancement of the sheath over the lead. Our report highlights that Riata ICD leads are prone to externalization of the conductor wires, which may render an indicated lead extraction procedure of these leads more challenging. A laser powered sheath may facilitate the procedure, especially in the presence of extensive adhesions and fibrosis.