Lead Extraction

Introduction

• Reasons to do it:
  • Infection (Class I)
  • Thromboembolic events (Class I)
  • SVC Syndrome + Symptoms
  • Ipsilateral venous occlusion (and using the other side) (Class I)
  • Causing malfunction or arrhythmia (Class I)
  • Interfering with treatment of malignancy (Class I)
  • Arrhythmias triggered by leads
  • Pain
  • Risk of perforation (or active perforation)
• Pathology
  • After implantation: Thrombus formation after weeks and then fibrosis occurs around the leads
• Traditionally traction + CV surgery were the only ways
  • Leads are now thinner, can break. 
  • Risk of myocardial rupture
  • Surgery had high morbidity
• Predictors of complications:
  • Implant duration
  • female gender
  • ICD removal
  • Use of laser lead extraction (laser = less complications)