Lead Extraction

    Table of contents

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    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)
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