Complications and lead extraction in cardiac pacing and defibrillation

Abstract

The only indications for which lead extraction may be really necessary are infected pacing or defibrillation systems. Superfluous non-functional leads can on the whole be more safely abandoned than extracted. Improvements in lead extraction will be more helped by designing and implanting leads that can be more easily removed than current models, than with better extraction tools. Still, as infection and hence lead extraction usually follows surgical interventions of a pacing or defibrillation system, avoiding the latter -or postponing it if possibleis of great importance (Neth Heart J 2008;16 (suppl 1):S28-S31.)

Dual- versus single-coil implantable defibrillator leads: review of the literature

“…Regarding the specific placement of the proximal defibrillation coil in dual-coil ICD lead systems, the presence of a proximal SVC defibrillation coil may add additional risk in transvenous lead extraction [1,58,59]. Several publications describe the proximal coil of dual-coil lead systems as a special technical problem, consuming additional time and increasing risk for serious complications [59][60][61]66]. Despite these reports there are no reliable clinical data comparing the extraction of dualversus single-coil leads.…”

“…Even in very experienced hands, transvenous ICD-lead extraction is associated with a significant interventionrelated complication rate [2,[56][57][58][59][60][61][62][63][64][65][66][67]. The extraction of dual-coil ICD leads may be associated with an increased risk, compared to the extraction of single-coil leads or pacing leads [1,58,59].…”

Are Dual‐Coil ICD Leads Obsolete?

“…It has been suspected for some time that the extraction of dual‐coil leads may be associated with increased risk compared to single‐coil leads given the fibrous tissue in growth and adherence of the coil to the thin wall of the SVC or right atrium . Epstein et al recently reported a retrospective study involving extraction of 273 single‐coil leads and 1,791 dual‐coil leads from nine high‐volume centers.…”

Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads

“…An inherent sequela of this is an increased need for CIED extraction which carries a significant acute morbidity and mortality and is associated with poor long‐term outcomes . The decision to proceed with CIED extraction needs to be weighed carefully, particularly in cases where extraction is not absolutely clinically mandated . Appropriate indications for CIED and lead extraction are detailed in the 2008 Heart Rhythm Society (HRS) Consensus document.…”

“…clinically mandated. 2,[4][5][6][7] Appropriate indications for CIED and lead extraction are detailed in the 2008 Heart Rhythm Society (HRS) Consensus document. This document and published registry data serve as a guide to best practice but these repositories make no mention of the risk of repeat transvenous lead extraction (TLE).…”