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  • Review Article
  • Published:

Considerations for cardiac device lead extraction

Nature Reviews Cardiology volume 13, pages 221–229 (2016)Cite this article

Subjects

Key Points

  • Lead extraction procedures are becoming common owing to the growing number of implantations in an ageing population, frequent device infections, and lead recalls and malfunctions

  • The most common indication for lead extraction is infection

  • Lead extraction procedures need to be performed at specialized centres because major complications, such as perforation or avulsion, can occur

  • Manual mechanical dilatation sheaths or those powered mechanically or that use laser energy are safe methods of extraction

  • Lead management strategies should be a multidisciplinary, collaborative effort and include appropriate implantation techniques, infection prevention, and lead selection

Abstract

Extraction of cardiovascular implantable electronic device leads is the removal of a lead that has been implanted for >1 year or that requires more than a standard stylet. The number of these procedures has greatly increased over the past few decades owing to the growing demand for primary and secondary implantations in ageing populations, and an accompanying rise in revisions for complications, infections, and lead advisory safety alerts. In this Review, we present the most common indications and techniques used for extraction. Particular consideration is given to the extraction of leads with large vegetations, recalled leads, stented leads, and those placed in the coronary sinus. We also summarize the most relevant and contemporary data on safety, efficacy, and outcomes of lead extraction.

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Figure 1: Disruption of fibrotic attachments.
Figure 2: Grossly externalized cables of a Riata® lead (St. Jude Medical, USA).
Figure 3: Venogram before planned upgrade.
Figure 4: Adhesions on an extracted lead.
Figure 5: Nomogram for prediction of 30-day mortality after lead extraction24.
Figure 6: Use of a laser sheath in a venous branch of the coronary sinus for extraction of an Attain Starfix® (Medtronic, USA) active fixation lead.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Main Campus, 9500 Euclid Avenue, Cleveland, 44195, Ohio, USA

    Oussama Wazni & Bruce L. Wilkoff

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Both authors researched data for the article, discussed its content, and wrote, reviewed, and edited the manuscript before submission.

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Correspondence to Bruce L. Wilkoff.

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O.W. and B.L.W. have received honoraria from Spectranetics.

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Wazni, O., Wilkoff, B. Considerations for cardiac device lead extraction. Nat Rev Cardiol 13, 221–229 (2016). https://doi.org/10.1038/nrcardio.2015.207

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