Cardiovascular Implantable Electronic Device Lead Management and Extraction
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
...agnosis...
...y focus is on ICD leads due to their...
...able 1. DefinitionsHaving trouble viewing table...
Treatment
...atment...
Lead Survival
...and clinical scenario-specific strategy o...
...CIED Lead Management...
...d in a condition that will permit future ext...
...l consideration with the patient on...
...d abandonment or removal can be a useful treatme...
...ED Infection...
...ics are going to be prescribed, drawing at least...
...and culture of generator pocket tiss...
...transesophageal echocardiography is re...
...uation by physicians with specific expertise in CI...
...hageal echocardiography can be useful f...
...physicians with specific expertise in CI...
...ng may be considered to facilitate the...
...course of antibiotics based on identif...
...device and lead removal is recommended...
...l of epicardial leads and patches is recommended...
...plete device and lead removal is recommen...
...omplete device and lead removal is recommended...
...eful consideration of the implications...
...2. Risk Factors for CIED InfectionHaving tr...
...ions for Lead Extraction (Noninfectious)...
.../or lead removal can be useful for patients wit...
...removal is recommended for patients with c...
...d removal is recommended for patients...
...val is recommended for patients with planned stent...
...removal as part of a comprehensive pl...
...ead removal can be useful for patients...
...s recommended for patients with life-th...
...moval can be useful for patients wi...
...be useful for patients if a CIED implantati...
...can be useful for patients with an abandoned...
...moval may be considered for patients with lead...
...may be considered for patients to facilitate...
...d removal may be considered in the sett...
...procedural Management...
...ase Perform a comprehensive history and physi...
...s and Follow-up...
...programs and operator-specific informati...
...able 3. Lead Abandonment Clinical Scenar...
...le 4. Factors Associated with Extraction...
...e 5. Extraction Procedure-Related ComplicationsH...
...agement of Suspected CIED Infection...
...2. Management of Suspected Pocket Infe...
...re 3. Management of Bacteremia without Evi...