From lead management to implanted patient management: indications to lead extraction in pacemaker and cardioverter–defibrillator systems

Abstract

Based on the published results primarily from cohort studies, percutaneous lead extraction is now considered a safe procedure and indications for its use have broadened from device-related infections to less strict indications, such as recurrent isolated bacteremia, asymptomatic upper vein occlusion and malfunctioning/redundant leads. Almost 50% of electrophysiologists consider lead extraction in these latter situations. To broaden its implementation, further prospective evaluation against conservative approaches is still needed. Rather than only aiming at short-term results, this technique should be integrated into wide-ranging tailored long-term strategies to manage all of the different issues of implanted patients.

Keywords::

• cardioverter–defibrillator
• cost
• cost–effectiveness
• healthcare system
• infection
• lead extraction
• pacemaker

Acknowledgements

The authors are grateful to Giulia Massaro for drawing assistance.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.