Extraction of implanted transvenous pacing leads: A review of a persistent clinical problem

Thrombolysis is an appropriate treatment in lead-associated infective endocarditis with giant vegetations located on the right atrial lead

“…Surgical therapy with exploration of the right chambers and the pulmonary arteries under full cardiopulmonary bypass containing lead extraction and embolectomy is the classic treatment6–8 of CD infection with large thrombotic vegetations, if transvenous extraction cannot be performed. Current guidelines suggest early cardiac surgical intervention, especially if a prosthetic intracardiac device is involved 10…”

“…But the death rates are still up to 12.5% 6–8. Several clinical trials have shown that a pharmacological treatment without explantation of the entire hardware is obsolete.…”

Nonstaphylococcal Infections of Cardiac Implantable Electronic Devices

“…6 Reasons for the higher rate of infection during the early period after CIED implantation include perioperative contamination and the lack of ensheathment of the leads in fibrocollagenous tissue until a few months after placement, thereby making them more prone to microbiological attachment. 14 Compared with staphylococci, nonstaphylococcal organisms appear to be less virulent, result in more protracted clinical manifestations of CIED infection before hospital admission, and are less lethal with a low infection-related mortality of 4% compared with 9% for S aureus. 10 Seven individuals in our study did not have their CIED completely removed because of high surgical risk and had to be treated with partial removal of the infected device or antibiotic therapy alone without recurrence of infection within 6 months of follow-up (Table 5).…”

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“…[4][5][6][7] The old techniques of external traction using weights, pulleys, and adhesive tape had limited success and an abundance of serious complications. Until very recently, the only methods available for removing chronically implanted leads were traction or cardiac surgical procedures with or without a bypass.…”