How to prevent, recognize, and manage complications of lead extraction. Part III: Procedural factorsThe 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.
How to prevent, recognize, and manage complications of lead extraction. Part II: Avoiding lead extraction—Noninfectious issuesThe first part of this review examined the infectious indications for lead extraction. This part discusses noninfectious indications for lead extraction and strategies for reducing the incidence of such indications.
How to prevent, recognize, and manage complications of lead extraction. Part I: Avoiding lead extraction—Infectious issuesAs 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.