From Guidelines: Definitions, Indications, Facilities, and Outcomes of Transvenous Lead Extraction

  • Roberto Verlato
  • Maria Stella Baccillieri
  • Pietro Turrini


Lead removal is removal of a pacing or defibrillator lead using any technique. It includes two completely different procedures: lead explant and lead extraction. Lead explant is the removal of a lead using simple traction techniques, which is usually possible for leads implanted for less than 1 year. Lead extraction is removal of a lead implanted for more than 1 year or that requires the assistance of specialized equipment in order to be removed. Lead extraction is by far the more complex procedure. As it carries some risks for the patient, clear indications, expertly trained personnel, adequate tools, and appropriate environment and facilities are mandatory for its safe removal [1], [2].


Cardiac Resynchronization Therapy Infective Endocarditis Left Ventricular Lead Lead Removal Lead Extraction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Love CJ, Wilkoff BL, Byrd CL et al (2000) Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. Pacing Clin Electrophysiol 23(4):544–551PubMedCrossRefGoogle Scholar
  2. 2.
    Wilkoff BL, Love CJ, Byrd CL et al (2009) Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training indications and patient management. Heart Rhythm 6:1086–1104CrossRefGoogle Scholar
  3. 3.
    ACC/AHA Task Force on Practice Guidelines (2006) Methodology manual for ACC/AHA Guideline Writing Committees.
  4. 4.
    Uslan DZ, Sohail MR, St Sauver JL et al (2007) Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med 167:669–675PubMedCrossRefGoogle Scholar
  5. 5.
    Sohail MR, Uslan DZ, Khan AH et al (2007) Risk factor analysis of permanent pacemaker infection. Clin Infect Dis 45:166–173PubMedCrossRefGoogle Scholar
  6. 6.
    Klug D, Balde M, Pavin D et al (2007) Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation 116:1349–1355PubMedCrossRefGoogle Scholar
  7. 7.
    Urslan DZ, Sohail MR, Friedman PA et al (2006) Frequency of permanent pacemaker or implantable cardioverter-defibrillator infection in patients with gram-negative bacteremia. Clin Infect Dis 43:731–736CrossRefGoogle Scholar
  8. 8.
    Bailey SM, Wilkoff BL (2006) Complications of pacemakers and defibrillators in the elderly. Am J Geriatr Cardiol 15:102–107PubMedCrossRefGoogle Scholar
  9. 9.
    Klug D, Wallet F, Kacet S et al (2005) Detailed bacteriologic tests to identify the origin of transvenous pacing system infections indicate a high prevalence of multiple organisms. Am Heart J 149:322–328PubMedCrossRefGoogle Scholar
  10. 10.
    Wilkoff BL (2007) How to treat and identify device infections. Heart Rhythm 4:1467–1470PubMedCrossRefGoogle Scholar
  11. 11.
    Chua DY, Wilkoff BL, Lee I et al (2000) Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med 133(8):604–608PubMedGoogle Scholar
  12. 12.
    Sohail MR, Uslan DZ, Khan AH et al (2007) Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol 49:1851–1859PubMedCrossRefGoogle Scholar
  13. 13.
    Road I (1998) Intravascular catheter-related infections. Lancet 351:893–898CrossRefGoogle Scholar
  14. 14.
    Dy Chua J, Abdul-Karim A, Mawhorter S et al (2005) The role of swab and tissue culture in the diagnosis of implantable cardiac device infection. Pacing Clin Electrophysiol 28:1276–1281CrossRefGoogle Scholar
  15. 15.
    Klug D, Lacroix D, Savoye C et al (1997) Systemic infection related to endocarditis on pacemaker leads: clinical presentation and management. Circulation 95:2098–2107PubMedCrossRefGoogle Scholar
  16. 16.
    Mansur AJ, Grinberg M, Costa R et al (1984) Dura mater valve endocarditis related to retained fragment of postoperative temporary epicardial pacemaker lead. Am Heart J 108:1049–1052PubMedCrossRefGoogle Scholar
  17. 17.
    Klug D, Wallet F, Kacet S et al (2003) Involvement of adherence and adhesion Staphylococcus epidermidis genes in pacemaker lead-associated infections. J Clin Microbiol 41:3348–3350PubMedCrossRefGoogle Scholar
  18. 18.
    Klug D, Wallet F, Lacroix D et al (2004) Local symptoms at the site of pacemaker implantation indicate latent systemic infection. Heart 90:882–886PubMedCrossRefGoogle Scholar
  19. 19.
    Rubio-Alvarez J, Duran-Munoz D, Sierra-Quiroga J et al (1989) Right heart endocarditis and endocardial pacemakers. Ann Thorac Surg 48:147–151PubMedCrossRefGoogle Scholar
  20. 20.
    Schwartz IS, Pervez N (1971) Bacterial endocarditis associated with a permanent transvenous cardiac pacemaker. JAMA 218:736–737PubMedCrossRefGoogle Scholar
  21. 21.
    Coman LC, Levison ME (1975) Sustained bacteremia and transvenous cardiac pacemakers. JAMA 233:264–266CrossRefGoogle Scholar
  22. 22.
    Bluhm G (1985) Pacemaker infections. Acta Medica Scand Suppl 699:1–62Google Scholar
  23. 23.
    Arber N, Prass E, Copperman Y et al (1994) Pacemaker endocarditis: report of 44 cases and review of the literature. Medicine 73:299–305PubMedCrossRefGoogle Scholar
  24. 24.
    Del Rio A, Anguera I, Miro JM et al (2003) Surgical treatment of pacemaker and defibrillator lead endocarditi. Impact of electrode lead extraction on outcome. Chest 124:1451–1459PubMedCrossRefGoogle Scholar
  25. 25.
    Cleland JG, Daubert JC, Erdmann E et al, for the Cardiac Heart Failure (care-HF) Study Investigators (2005) The effect of cardiac resynchronization on morbidity and mortality. N Engl J Med 352:1539–1549PubMedCrossRefGoogle Scholar
  26. 26.
    Young JB, Abraham WT, Smith AL et al, for the Multicenter Insynch ICD Randomized Clinical Evaluation (MIRACLE ICD) Trial Investigators (2003) Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: The MIRACLE ICD Trial. JAMA 289:2719–2721CrossRefGoogle Scholar
  27. 27.
    Moss AJ, Zareba W, Hall WJ et al (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883PubMedCrossRefGoogle Scholar
  28. 28.
    Cabell CH, Heidenreich PA, Chu VH et al (2004) Increasing rates of cardiac device infections among Medicare beneficiaries: 1990–1999. Am Heart J 147:582–586PubMedCrossRefGoogle Scholar
  29. 29.
    Voigt A, Shalaby A, Saba S (2006) Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003. J Am Coll Cardiol 48:590–592PubMedCrossRefGoogle Scholar
  30. 30.
    Da Costa A, Kirkorian G, Cucherat M et al (1998) Antibiotic prophylaxis for permanent pacemaker implantation: a meta-analysis. Circulation 97:1796–1801PubMedCrossRefGoogle Scholar
  31. 31.
    Harcombe AA, Newell SA, Ludman PF et al (1998) Late complications following pacemaker implantation or elective unit replacement. Heart 80:240–244PubMedGoogle Scholar
  32. 32.
    Gould PA, Krahn AD, for The Canadian Heart Rhythm Society Working Group on Device Advisories (2006) Complications associated with implantable cardioverter-defibrillator replacement in response to device advisory. JAMA 295:1907–1911PubMedCrossRefGoogle Scholar
  33. 33.
    Baddour LM, Bettmann MA, Bolger AF et al (2003) Nonvalvular cardiovascular device-related infections. AHA scientific statement. Circulation 108: 2015–2031PubMedCrossRefGoogle Scholar
  34. 34.
    Donlan RM (2001) Biofilm formation: a clinically relevant microbiological process. Clin Infect Dis 33:1387–1392PubMedCrossRefGoogle Scholar
  35. 35.
    Bell M (2001) Biofilms: a clinical perspective. Curr Infect Dis Rep. 3:483–486PubMedCrossRefGoogle Scholar
  36. 36.
    O’Gara JP, Humphreys H (2001) Staphylococcus epidermidis biofilms: importance and implications. J Med Microbiol 50:582–587PubMedGoogle Scholar
  37. 37.
    Baddour LM, Wilson RW, Bayer AS et al (2005) Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications. A statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease. Circulation 111:e394–e434PubMedCrossRefGoogle Scholar
  38. 38.
    Fowler VG, Li J, Corey GR et al (1997) Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients. J Am Coll Cardiol 30:1072–1078PubMedCrossRefGoogle Scholar
  39. 39.
    Bracke FA, Meijer A, van Gelder LM (2001) Pacemaker lead complications: when is extraction appropriate and what can we learn from published data? Heart 85:254–259PubMedCrossRefGoogle Scholar
  40. 40.
    Cacoub P, Leprince P, Nataf P et al (1998) Pacemaker infective endocarditis. Am J Cardiol 82:480–484PubMedCrossRefGoogle Scholar
  41. 41.
    Chamis AL, Peterson GE, Cabell CH et al (2001) Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillator. Circulation 104:1029–1033PubMedCrossRefGoogle Scholar
  42. 42.
    Victor F, De Place C, Camus C et al (1999) Pacemaker lead infection: echocardiographic features, management and outcome. Heart 81:82–87PubMedGoogle Scholar
  43. 43.
    Ruttmann E, Hangler HB, Kilo J et al (2006) Transvenous pacemaker lead removal is safe and effective even in large vegetations: an analysis of 53 cases of pacemaker lead endocarditis. Pacing Clin Electrophysiol 29:231–236PubMedCrossRefGoogle Scholar
  44. 44.
    Byrd CL (2007) Managing device-related complications and transvenous lead extractions. In Ellenbogen KA, Kay GN, Wilkoff BL, Lau CP (eds.) Clinical cardiac pacing, defibrillation and resynchronization therapy (3rd edn) Saunders, Philadelphia, pp 855–930CrossRefGoogle Scholar
  45. 45.
    Lakkireddy DR, Verma A, Wilkoff BL (2005) Current concepts in intravascular pacemaker and defibrillator lead extraction. In: Wang, Paul J (ed) New arrhythmia technologies. Gerald V. Naccarelli, Michael R, Rosen NA, Mark Estes III, David L. Hayes, David E. Haines (co-eds). Blackwell-Futura Publishing, Malden pp 124–133CrossRefGoogle Scholar
  46. 46.
    Borek PP, Wilkoff BL (2008) Pacemaker and ICD leads: strategies for long-term management. J Interv Card Electrophysiol 23:59–72PubMedCrossRefGoogle Scholar
  47. 47.
    Jones SO, Eckart RE, Albert CM et al (2008) Large, single-center, single-operator experience with transvenous lead extraction: outcomes and changing indications. Heart Rhythm 5:520–525PubMedCrossRefGoogle Scholar
  48. 48.
    Kar AK, Ghosh S, Majundar A et al (2000) Venous obstruction after permanent pacing. Indian Heart J 52:431–433PubMedGoogle Scholar
  49. 49.
    Barakat K, Robinson NM, Spurrell RA (2000) Transvenous pacing lead-induced thrombosis: a series of cases with review of the literature. Cardiology 93:142–148PubMedCrossRefGoogle Scholar
  50. 50.
    Sticherling C, Chough SP, Baker RL et al (2001) Prevalence of central venous occlusion in patients with chronic defibrillators leads. Am Heart J 141:813–816PubMedCrossRefGoogle Scholar
  51. 51.
    Tse HF, Lau CP (1997) Long-term effects of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol 29:744–749PubMedCrossRefGoogle Scholar
  52. 52.
    Pastore G, Noventa F, Piovesana PG et al (2008) Left ventricular dyssynchrony resulting from right ventricular apical pacing. Relevance of baseline assessment. Pacing Clin Electrophysiol 31:1456–1462PubMedCrossRefGoogle Scholar
  53. 53.
    Gula LJ, Ames A, Woodburne A et al (2005) Central venous occlusions not an obstacle to device upgrade with the assistance of laser extraction. Pacing Clin Electrophysiol 28:661–666PubMedCrossRefGoogle Scholar
  54. 54.
    Worley SJ, Gohn DC, Pulliam RW (2008) Over the wire lead extraction and focused force venoplasty to regain venous access in a totally occluded subclavian vein. J Interv Electrophysiol 23:135–137CrossRefGoogle Scholar
  55. 55.
    Henrikson CA, Alexander D, Ringel RE et al (2006) Laser recanalization of the subclavian vein. Pacing Clin Electrophysiol 29:436:437PubMedCrossRefGoogle Scholar
  56. 56.
    Jarvinen A, Harjiula A, Verkkala K (1986) Intrathoracic surgery for retained endocardial leads. Thorac Cardiovasc Surg 34:94–97PubMedCrossRefGoogle Scholar
  57. 57.
    Dubernet J, Irarrazaval MJ, Lema G et al (1985) Surgical removal of entrapped endocardial leads without using extracorporeal circulation. Pacing Clin Electrophysiol 8:175–180PubMedCrossRefGoogle Scholar
  58. 58.
    Chan AW, Bhatt DL, Wilkoff BL et al (2002) Percutaneous treatment for pacemaker-associated superior vena cava syndrome. Pacing Clin Electrophysiol 25:1628–1633PubMedCrossRefGoogle Scholar
  59. 59.
    Crowe MT, Davies CH, Gaines PA (1995) Percutaneous management of superior vena cava occlusions. Cardiovasc Intervent Radiol 18:367–372PubMedCrossRefGoogle Scholar
  60. 60.
    Shah R, Sabanathan S, Lowe RA et al (1996) Stenting in malignant obstruction of superior vena cava. J Thorac Cardiovasc Surg 112:335–340PubMedCrossRefGoogle Scholar
  61. 61.
    Gross CM, Kramer J, Waigand J et al (1997) Stent implantation in patients with superior vena cava syndrome. AJR Am J Roentgenol 169:429–432PubMedGoogle Scholar
  62. 62.
    Schindler N, Vogelzang RL (1999) Superior vena cava syndrome. Experience with endovascular stents and surgical therapy. Surg Clin North Am 79:683–694PubMedCrossRefGoogle Scholar
  63. 63.
    Oderich GS, Treiman GS, Schneider P et al (2000) Stent placement for treatment of central and peripheral venous obstruction: A long-term multi-institutional experience. J Vasc Surg 32:760–769PubMedCrossRefGoogle Scholar
  64. 64.
    Byrd CL, Wilkoff BL, Love CJ et al (1999) Intravascular extraction of problematic or infected permanent pacemaker leads: 1994–1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol 22:1348–1357PubMedCrossRefGoogle Scholar
  65. 65.
    Wazni O, Epstein LM, RG Carrillo et al (2010) Lead extraction in the contemporary setting: The LExICon Study: An observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol 55:579–586PubMedCrossRefGoogle Scholar
  66. 66.
    Anderson JM (1988) Inflammatory response to implants. ASAIO Trans 11:101–107CrossRefGoogle Scholar
  67. 67.
    Schoen FJ, Harasaki H, Kim KM et al (1988) Biomaterial-associated calcification: pathology, mechanisms, and strategies for prevention. J Biomed Mater Res 22:11–36PubMedGoogle Scholar
  68. 68.
    Woscoboinik JR, Maloney JD, Helguera ME et al (1992) Pacing lead survival: performance of different models. Pacing Clin Electrophysiol 15:1991–1995PubMedCrossRefGoogle Scholar
  69. 69.
    Bohm A, Pinter A, Duray G et al (2001) Complications due to abandoned noninfected leads. Pacing Clin Electrophysiol 24:1721–1724PubMedCrossRefGoogle Scholar
  70. 70.
    Suga C, Hayes DL, Hyberger LK et al (2000) Is there an adverse outcome from abandoned pacing leads? J Interv Card Electrophysiol 4: 493–499PubMedCrossRefGoogle Scholar
  71. 71.
    Silvetti MS, Drago F (2008) Outcome of young patients with abandoned, nonfunctional endocardial leads. Pacing Clin Electrophysiol 31:473–479PubMedCrossRefGoogle Scholar
  72. 72.
    Glikson M, Suleiman M, Luria DM et al (2009) Do abandoned leads pose risk to implantable cardioverter-defibrillator patients? Heart Rhythm 6:65–68PubMedCrossRefGoogle Scholar
  73. 73.
    Pfitzner P, Trappe HJ (1998) Oversensing in a cardiac defibrillator system caused by interaction between two endocardial defibrillation leads in the right ventricle. Pacing Clin Electrophysiol 21:764–768PubMedCrossRefGoogle Scholar
  74. 74.
    Lickfett L, Wolpert C, Jung W et al (1999) Inappropriate implantable defibrillator discharge caused by a retained pacemaker lead fragment. J Interv Card Electrophysiol 3:163–167PubMedCrossRefGoogle Scholar
  75. 75.
    Lloyd MA, Hayes DL, Holmes DR Jr et al (1996) Extraction of the Telectronics Accufix 330-801 atrial lead: the Mayo Clinic experience. Mayo Clin Proc 71:230–234PubMedCrossRefGoogle Scholar
  76. 76.
    Daoud EG, Kou W, Davidson T et al (1996) Evaluation and extraction of the Accufix atrial J lead. Am Heart J 131:266–269PubMedCrossRefGoogle Scholar
  77. 77.
    Kawanishi DT, Brinker JA, Reeves R et al (1998) Kaplan-Meier analysis of freedom from extraction or death in patients with an Accufix J retention wire atrial permanent pacemaker lead: a potential management tool. Pacing Clin Electrophysiol 21:2318–2321PubMedCrossRefGoogle Scholar
  78. 78.
    Kawanishi DT, Brinker JA, Reeves R et al (1998) Spontaneous versus extraction related injuries associated with Accufix J-wire atrial pacemaker lead: tracking changes in patient management. Pacing Clin Electrophysiol 21:2314–2317PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Roberto Verlato
    • 1
  • Maria Stella Baccillieri
    • 1
  • Pietro Turrini
    • 1
  1. 1.Interventional Electrophysiology Unit, Cardiovascular DepartmentP. Cosma HospitalCamposampiero (PD)Italy

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