LAUSR

: A 39-year-old male presented with an epicardial ICD system infection. He had separate shock leads placed in posterior epicardium and subcutaneously, and a transvenous pace-sense lead. A Tightrail sheath under direct visualisation successfully extracted the pericardial lead and avoided the need for sternotomy. This is the first description of an epicardial shock lead extracted with a rotating mechanical cutting tool. case highlights the utility of specialised extraction tools for removal of leads in the pericardial space, thereby preventing the need for sternotomy and avoiding myocardial or coronary artery injury. – Abstract: 1 A 39-year-old male presented with an epicardial ICD system infection. He had separate shock leads 2 placed in posterior epicardium and subcutaneously, and a transvenous pace-sense lead. A Tightrail 3 sheath under direct visualisation successfully extracted the pericardial lead and avoided the need for 4 sternotomy. This is the first description of an epicardial shock lead extracted with a rotating 5 mechanical cutting tool.