Cardiovascular Implantable Electronic Device Lead Management and Extraction

Publication Date: September 14, 2017

Key Points

Key Points

  • Over the past 60 years, CIEDs have become established as an important therapeutic modality of cardiovascular care for the treatment of patients with bradycardia, tachycardia, and heart failure.
  • Although recent technological advances have eliminated the need for transvenous or epicardial leads for CIEDs used in selected groups of patients, lead management remains critical for a variety of reasons.
  • Recent estimates suggest that 1.2–1.4 million CIEDs are implanted annually worldwide.
  • Questions on lead management arise in a number of situations, including when changes in a patient’s clinical condition make a different functionality more or less important, if a lead becomes nonfunctional, and if the presence of a lead is thought to interfere with the patients' optimal treatment.

Diagnosis

...iagnos...

...mary focus is on ICD leads due to their hi...


...tionsHaving trouble viewing table? Expand...


Treatment

Treatment

...ead Surviva...

...lead model and clinical scenario-sp...


...CIED Lead Management...

Leaving the lead in a condition that will...

...ul consideration with the patient on the decis...

...onment or removal can be a useful treatment st...


...IED Infecti...

...ntibiotics are going to be prescribed, drawing...

Gram stain and culture of generator pocket ti...

Preprocedural transesophageal echocardiography...

...on by physicians with specific expertise in CIE...

...echocardiography can be useful for patients...

...ation by physicians with specific expertise...

...ing may be considered to facilitate the di...

...ete course of antibiotics based on...

...ice and lead removal is recommended for all patien...

...ete removal of epicardial leads and pa...

...plete device and lead removal is r...

...omplete device and lead removal is recommen...

...deration of the implications of oth...


...2. Risk Factors for CIED InfectionHa...


...cations for Lead Extraction (Noni...

...ead removal can be useful for patients...

...al is recommended for patients with cl...

...is recommended for patients with SVC stenos...

...is recommended for patients with planned ste...

...al as part of a comprehensive plan for maintainin...

...d removal can be useful for patients with ipsilate...

...val is recommended for patients wit...

...be useful for patients with a CIED location...

...d removal can be useful for patient...

...oval can be useful for patients with an a...

...removal may be considered for patients with...

...val may be considered for patients to facilitat...

...ay be considered in the setting of normally...


...riprocedural Managem...

...eparatory Phase Perform a comprehensive his...


...utcomes and Follow-up...

...grams and operator-specific informati...


...ead Abandonment Clinical ScenariosHaving tro...


...Factors Associated with Extraction...


...ion Procedure-Related ComplicationsH...


Figure 1. Management of Suspected CIED Infecti...


...anagement of Suspected Pocket Infect...


...3. Management of Bacteremia without Evidence...