Lead management frequently asked questions
What is lead extraction?
Pacemakers and ICD leads are inserted through veins that travel to the heart and the ends of the leads are positioned inside the heart. Over time, scar tissue and adhesions can form causing the leads to become attached to the veins and heart muscle. Lead extraction is a procedure where the leads are removed using specialized tools that can free the leads from the scar tissue and adhesions. This can often be performed non-invasively through the pacemaker or ICD implant site using a laser or cutting tool. Lead extraction is a safe and effective procedure when it is performed by an experienced team.
Clinical scenarios where lead management decisions need to be made:
- Malfunction or recall of a pacemaker or ICD lead
- Device upgrade or revision
- Venous occlusion
- Implant site (pocket) infection
- Blood stream infection
- MRI contraindication due to the presence of an abandoned lead
- Patient desire to have system removed because of personal preference or no further indication
What are the benefits of abandoning leads that are not functioning or no longer needed?
What are the risks of abandoning leads that are not functioning or no longer needed?
What are the benefits of extracting leads that are not functioning or no longer needed?
What are the risks of extracting leads that are not functioning or no longer needed?
What precautions do we take to perform lead extraction safely?
Reference:
- Hussein A, Tarakji KG, Martin DO, et al. Cardiac implantable device infections: added complexity and suboptimal outcomes with previously abandoned leads. J Am Coll Cardiol. 2016;1(3).
- Brunner MP, Cronin EM, Wazni O, et al. Outcomes of patients requiring emergency surgical or endovascular intervention for catastrophic complications during transvenous lead extraction. Heart Rhythm. 2014;11(3)419-25.
- Wazni O, Epstein LM, Carillo RG, et al. Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extraction. J Am Coll Cardiol. 2010;55(6):579-586.