The techniques and tools for percutaneous removal of transvenous leads have undergone
substantial development over the past several decades. Although the use of locking
stylets and powered sheaths to free leads from encapsulated scar tissue has improved
the success rate, the procedure still carries a significant risk of morbidity and
mortality even in the hands of experienced operators. The threshold for lead extraction
continues to evolve. The initial use of the procedure was limited to patients with
life-threatening infections because of limited tools, lower success rates and high
complication rates. Improved technology has increased the success rate and allowed
indications to expand. The dramatic growth in implantation of cardiac devices has
resulted in an exponential increase in the number of implanted leads. Unfortunately
this increase in implantation has also occurred at a time of increasing device advisories
and recalls.
1
,
2
Additional demand for lead extraction has occurred with the need to upgrade pacing
systems to implantable cardioverter defibrillators (ICDs) and resynchronization devices
in the setting of venous occlusion. Extraction of a chronically implanted lead should
be performed by an experienced operator only after careful consideration of the individual
risk/benefit ratio. This article will discuss the risks, indications, and essential
requirements for lead extraction. The techniques of lead extraction will be discussed
in a separate article.Keywords
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References
- Changing trends in pacemaker and implantable cardioverter defibrillator generator advisories.Pacing Clin Electrophysiol. 2002; 25: 1670-1678
- Recalls and safety alerts involving pacemakers and implantable cardioverter-defibrillator generators.JAMA. 2001; 286: 793-799
- Clinical study of the laser sheath for lead extraction: the total experience in the United States.Pacing Clin Electrophysiol. 2002; 25: 804-808
- Risks of spontaneous injury and extraction of an active fixation pacemaker lead: report of the Accufix Multicenter Clinical Study and Worldwide Registry.Circulation. 1999; 100: 2344-2352
- Pacemaker lead complications: when is extraction appropriate and what can we learn from published data?.Heart. 2001; 85: 254-259
- Extraction of pacemaker and implantable cardioverter defibrillator leads: patient and lead characteristics in relation to the requirement of extraction tools.Pacing Clin Electrophysiol. 2002; 25: 1037-1040
- Intravascular extraction of problematic or infected permanent pacemaker leads: 1994–1996.Pacing Clin Electrophysiol. 1999; 22: 1348-1357
- Implantable cardioverter defibrillator lead complications and laser extraction in children and young adults with congenital heart disease: implications for implantation and management.J Cardiovasc Electrophysiol. 2003; 14: 344-349
- Laser assistance for extraction of chronically implanted endocardial leads: infectious versus noninfectious indications.Pacing Clin Electrophysiol. 2006; 29: 1352-1358
- Learning curve characteristics of pacing lead extraction with a laser sheath.Pacing Clin Electrophysiol. 1998; 21: 2309-2313
- Laser lead extraction: is there a learning curve?.Pacing Clin Electrophysiol. 2005; 28: 180-184
- Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training.Pacing Clin Electrophysiol. 2000; 23: 544-551
- Contemporary Outcomes of Lead Extractions in a High-Volume Center.Heart Rhythm. 2007; 4: S203
- Increasing rates of cardiac device infections among Medicare beneficiaries: 1990-1999.Am Heart J. 2004; 147: 582-586
- Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003.J Am Coll Cardiol. 2006; 48: 590-591
- Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study.Arch Intern Med. 2007; 167: 669-675
- Complications associated with implantable cardioverter-defibrillator replacement in response to device advisories.JAMA. 2006; 295: 1907-1911
- Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections.J Am Coll Cardiol. 2007; 49: 1851-1859
- Surgical treatment of pacemaker and defibrillator lead endocarditis: the impact of electrode lead extraction on outcome.Chest. 2003; 124: 1451-1459
- Local symptoms at the site of pacemaker implantation indicate latent systemic infection.Heart. 2004; 90: 882-886
- Surgical lead-preserving procedures for pacemaker pocket infection.Ann Thorac Surg. 2002; 74 (discussion 1499): 1494-1499
- Intravascular pacemaker and defibrillator lead extraction: a state-of-the-art review.Heart Rhythm. 2004; 1: 739-745
- Successful laser-assisted percutaneous extraction of four pacemaker leads associated with large vegetations.Pacing Clin Electrophysiol. 2000; 23: 1260-1262
- Endocardial pacemaker or defibrillator leads with infected vegetations: a single-center experience and consequences of transvenous extraction.Am Heart J. 2003; 146: 339-344
- Successful laser-assisted removal of an infected ICD lead with a large vegetation.Pacing Clin Electrophysiol. 2006; 29: 910-913
- Transvenous pacemaker lead removal is safe and effective even in large vegetations: an analysis of 53 cases of pacemaker lead endocarditis.Pacing Clin Electrophysiol. 2006; 29: 231-236
- Frequency of permanent pacemaker or implantable cardioverter-defibrillator infection in patients with gram-negative bacteremia.Clin Infect Dis. 2006; 43: 731-736
- Modified temporary cardiac pacing using transvenous active fixation leads and external re-sterilized pulse generators.J Am Coll Cardiol. 2006; 47: 1487-1489
- Clinical experience with pacemaker pulse generators and transvenous leads: an 8-year prospective multicenter study.Heart Rhythm. 2007; 4: 154-160
- Long-term structural failure of coaxial polyurethane implantable cardioverter defibrillator leads.Pacing Clin Electrophysiol. 2002; 25: 879-882
- Annual Rate of Transvenous Defibrillation Lead Defects in Implantable Cardioverter-Defibrillators Over a Period of >10 Years.Circulation. 2007; 115: 2474-2490
- Retained pacemaker leads.J Thorac Cardiovasc Surg. 1987; 94: 770-772
- Long-term outcome of patients with multiple (> or = 3) noninfected transvenous leads: a clinical and echocardiographic study.Pacing Clin Electrophysiol. 2000; 23: 423-426
- Complications due to abandoned noninfected pacemaker leads.Pacing Clin Electrophysiol. 2001; 24: 1721-1724
- Is there an adverse outcome from abandoned pacing leads?.J Interv Card Electrophysiol. 2000; 4: 493-499
- Incidence of complications in patients with implantable cardioverter/defibrillator who receive additional transvenous pace/sense leads.Pacing Clin Electrophysiol. 2005; 28: 795-800
- Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads.J Cardiovasc Electrophysiol. 2004; 15: 1258-1262
- Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator.Europace. 2004; 6: 25-31
- Symptomatic occlusion of the access vein after pacemaker or ICD lead extraction.Heart. 2003; 89: 1348-1349
- A novel indication for transvenous lead extraction: upgrading implantable cardioverter defibrillator systems.J Interv Card Electrophysiol. 2000; 4: 523-528
- Central venous occlusion is not an obstacle to device upgrade with the assistance of laser extraction.Pacing Clin Electrophysiol. 2005; 28: 661-666
- Placement of transvenous pacemaker and ICD leads across total chronic occlusions.Pacing Clin Electrophysiol. 2005; 28: 921-925
- Pacemaker-induced superior vena cava syndrome: report of four cases and review of the literature.Pacing Clin Electrophysiol. 1989; 12: 1890-1895
- Superior vena cava occlusion and/or syndrome related to pacemaker leads.Am Heart J. 1993; 125: 831-837
- Delayed lead perforation: a disturbing trend.Pacing Clin Electrophysiol. 2005; 28: 251-253
- Delayed complications following pacemaker implantation.Pacing Clin Electrophysiol. 2002; 25: 1155-1158
- Recurrent pulmonary embolization following implantation of transvenous pacemaker.Pacing Clin Electrophysiol. 1984; 7: 790-793
- Right atrial thrombus and recurrent pulmonary emboli secondary to permanent cardiac pacing--a case report and short review of literature.Angiology. 1987; 38: 627-630
- Influence of radiotherapy on the latest generation of implantable cardioverter-defibrillators.Int J Radiat Oncol Biol Phys. 2005; 63: 282-289
- Influence of radiotherapy on the latest generation of pacemakers.Radiother Oncol. 2005; 76: 93-98
- Five-years experience with intravascular lead extraction.Pacing Clin Electrophysiol. 1994; 17: 2016-2020
Article info
Publication history
Published online: June 08, 2007
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© 2007 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
