Case of Frozen Leads: An Old but Persistent Challenge.

Frozen leads are a rare but clinically relevant complication during cardiac device replacement. A 77-year-old man undergoing pacemaker upgrade had atrial and ventricular leads firmly adhered to the generator header despite set screw removal and ethanol application. As specialized extraction tools were unavailable, an orthopedic nipper and forceps were used as a locking mechanism to dismantle the header, successfully freeing the leads without damage. This is the first reported case in which fully exposed lead pins could not be extracted. While adhesion limited to the pin port may be addressed with ethanol or fine needles, adhesion from the lead base requires header destruction, increasing damage risk. Specialized tools may not always be available, and in such scenarios, the described method may serve as a practical alternative. Thus, this case underscores the critical importance of meticulous blood and fluid removal during cardiac implantable electronic device (CIED) implantation to prevent frozen leads.