Lead extraction has grown from a “niche” procedure practiced by a select few individuals
to a fairly widely disseminated technique. With the apparent increase in device infections,
occluded veins and the need for device “upgrades,” more physicians are attempting
to extract chronically implanted pacing and implantable cardioverter-defibrillator
(ICD) leads. Unfortunately, obtaining training for this procedure is difficult outside
of a training program at a center with a physician experienced in lead extraction.
Of interest, in the field of interventional cardiology, 1 year of training is necessary,
yet for lead extraction, the “see one, do one” approach is accepted. Given the range
of tools, techniques, and situations that present themselves, such a casual approach
to a complex technique can hardly be endorsed. Indeed, the medicolegal consequences
of this cavalier approach have proved to be substantial. This review aims to serve
as a starting point, a guide, and an enhancement to the physician’s experience. It
is by no means meant to be a comprehensive manual for the physician to read and then
go buy some tools and “have at it.” Lead extraction can be a straightforward, uncomplicated
procedure, or it can degenerate into a life-threatening (or life-ending) situation
in moments.
Keywords
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References
- Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training.Pacing Clin Electrophysiol. 2000; 23;: 544-551
- Current concepts in extraction of transvenous pacing and ICD leads.Cardiol Clin. 2000; 18: 193-217
- Techniques and devices for lead extraction.in: Ellenbogen K.A. Kay N.G. Lau C.P. Wilkoff B.W. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy. Elsevier, Philadelphia2006 (Chapter 21)
- Extraction of pacing and defibrillator leads.in: Barold S.S. Mugica J.M. The Fifth Decade of Cardiac Pacing. Futura/Blackwell, Boston2004 (Chapter 5)
- Extraction of pacing leads: overview of current techniques.J Cardiovasc Electrophysiol. 2006; 17: 1-5
Article info
Publication history
Published online: July 19, 2007
Identification
Copyright
© 2007 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
