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How to prevent, recognize, and manage complications of lead extraction. Part III: Procedural factors

Published:February 28, 2008DOI:https://doi.org/10.1016/j.hrthm.2008.02.037
      The major risks of percutaneous lead extraction include cardiac perforation (1%–4%), emergency cardiac surgery (1%–2%), and death (0.4%–0.8%). However, risk to an individual varies in accordance with a number of factors (Table 1), and informed consent must be tailored to the specific patient. Indicators of very high risk (Table 2) define relative contraindications to the procedure; patients without other options should be referred to experienced centers capable of managing these special cases. Surgical backup should be secured prior to every extraction.
      Table 1Factors to consider when risk stratifying a patient for transvenous lead removal
      • 1
        Age of patient
      • 2
        Gender of patient
      • 3
        Comorbidities
      • 4
        Presence of calcification involving the lead(s)
      • 5
        Presence and size of vegetation(s) on the lead
      • 6
        Duration of implant
      • 7
        Fragility, condition, and physical characteristics of the lead
      • 8
        Multiple leads
      • 9
        Implantable cardioverter-defibrillator leads, especially with a superior vena cava coil
      Adapted from Love et al.
      • Love C.J.
      • Wilkoff B.L.
      • Byrd C.L.
      • et al.
      Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty.
      Table 2Relative contraindications for transvenous lead removal
      • 1
        Presence of calcification, visible on x-ray film, involving the lead in the atrium or superior vena cava
      • 2
        Patient is unsuitable candidate for emergent thoracotomy
      • 3
        Known or suspected placement of the lead(s) through structures other than normal venous and cardiac structures (e.g., subclavian artery, pericardial space, lung, left side of heart)
      • 4
        Presence of a very large (>2.5 cm) vegetation on a lead to be extracted
        • Love C.J.
        • Wilkoff B.L.
        • Byrd C.L.
        • et al.
        Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty.
      Adapted from Love et al.
      • Love C.J.
      • Wilkoff B.L.
      • Byrd C.L.
      • et al.
      Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty.

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