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How to select patients for lead extraction

      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.
      • Maisel W.H.
      • Stevenson W.G.
      • Epstein L.M.
      Changing trends in pacemaker and implantable cardioverter defibrillator generator advisories.
      • Maisel W.H.
      • Sweeney M.O.
      • Stevenson W.G.
      • Ellison K.E.
      • Epstein L.M.
      Recalls and safety alerts involving pacemakers and implantable cardioverter-defibrillator generators.
      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.

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