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How to prevent, recognize, and manage complications of lead extraction. Part I: Avoiding lead extraction—Infectious issues

Published:October 11, 2007DOI:https://doi.org/10.1016/j.hrthm.2007.10.018
      As the number of implanted devices continues to grow, so does the need for extraction of chronic endocardial leads. Extraction carries with it considerable risk of morbidity and mortality (both intraprocedure and postprocedure), even in experienced hands. Although the evolution of technology directed at this approach has facilitated the successful removal of leads, no evidence indicates that this technology has lessened the incidence or nature of adverse events. Risks associated with lead extraction include vascular and cardiac perforation, tricuspid valve injury, various arrhythmias, sepsis, pulmonary embolism, bleeding, stroke, and myocardial infarction. Among various published studies of extractions, procedural death related to device extraction has been remarkably consistent at 0.4% to 0.8%.
      • Kay G.N.
      • Brinker J.A.
      • Kawanishi D.T.
      • et al.
      Risks of spontaneous injury and extraction of an active fixation pacemaker lead: report of the Accufix Multicenter Clinical Study and Worldwide Registry.
      • Wilkoff B.L.
      • Byrd C.L.
      • Love C.J.
      • et al.
      Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial.
      • Byrd C.L.
      • Wilkoff B.L.
      • Love C.J.
      • et al.
      Clinical study of the laser sheath for lead extraction: the total experience in the United States.

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