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%.
1
,
2
,
3
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart RhythmAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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 extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial.J Am Coll Cardiol. 1999; 33: 1671-1676
- Clinical study of the laser sheath for lead extraction: the total experience in the United States.Pacing Clin Electrophysiol. 2002; 25: 804-808
- Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training.Pacing Clin Electrophysiol. 2000; 23: 544-551
- Increasing rates of cardiac device infections among Medicare beneficiaries: 1990–1999.Am Heart J. 2004; 147: 582-586
- High post-procedural mortality in lead extraction patients.Heart Rhythm. 2006; 3: S12
- Salvage of infected ICDs: management without removal.Pacing Clin Electrophysiol. 1996; 19: 437-442
- Surgical lead-preserving procedures for pacemaker pocket infection.Ann Thorac Surg. 2002; 74: 1494-1499
- Salvage of exposed implantable cardiac electrical devices and lead systems with pocket change and local flap coverage.Ann Plast Surg. 2007; 59: 26-29
- Local symptoms at the site of pacemaker implantation indicate latent systemic infection.Heart. 2004; 90: 882-886
- Surgical treatment of pacemaker and defibrillator lead endocarditis: the impact of electrode lead extraction on outcome.Chest. 2003; 124: 1451-1459
- Diagnosis and management of infections involving implantable electrophysiologic cardiac devices.Ann Intern Med. 2000; 133: 604-608
- Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators.Circulation. 2007; 116: 1349-1355
- Permanent pacemaker implantation in the cardiac catheterization laboratory versus the operating room: an analysis of hospital charges and complications.Pacing Clin Electrophysiol. 1992; 15: 2236-2239
- Implantation of permanent pacemakers in the electrophysiology laboratory: what it has changed in a general teaching hospital.Can J Cardiol. 2000; 16: 871-875
- Analysis of charges and complications of permanent pacemaker implantation in the cardiac catheterization laboratory versus the operating room.Pacing Clin Electrophysiol. 1999; 22: 1820-1824
- Operating theatre design.Lancet. 1999; 353: 1007-1010
- Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study.Clin Orthop Relat Res. 2005; 438: 204-208
- The plastic surgical adhesive drape: an evaluation of its efficacy as a microbial barrier.Ann Surg. 1976; 184: 46-50
- Pocket hematoma after pacemaker or implantable cardioverter defibrillator surgery: influence of patient morbidity, operation strategy, and perioperative antiplatelet/anticoagulation therapy.Chest. 2004; 126: 1177-1186
- Pacemaker and implantable cardioverter defibrillator implantation without reversal of warfarin therapy.Pacing Clin Electrophysiol. 2004; 27: 358-360
- Perioperative use of anti-platelet drugs.Best Pract Res Clin Anaesthesiol. 2007; 21: 241-256
- The impact of povidone-iodine pocket irrigation use on pacemaker and defibrillator infections.Pacing Clin Electrophysiol. 2005; 28: 789-794
- One stage side-to-side replacement of infected pulse generators and leads.Pacing Clin Electrophysiol. 2006; 29: 393-396
- Successful implantable cardioverter defibrillator placement in an ambulatory patient without thoracic venous access.J Cardiovasc Electrophysiol. 2004; 15: 716-718
- Images in cardiovascular medicine. “Shrink-wrapped” permanent pacemaker.Circulation. 2004; 110: e79
Article info
Publication history
Published online: October 11, 2007
Identification
Copyright
© 2008 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
