Malfunction of endocardial defibrillator leads and lead extraction: where do they meet?

The development of new extraction techniques has improved the success rate of intravascular extraction of pacemaker and defibrillator leads, and hence the practice of extraction is expanding. However, the indications for lead extraction of malfunctioning leads in patients with an implantable cardioverter defibrillator (ICD) are still not well established.

We reviewed the literature concerning structural complications of ICD leads. The clinical presentation and detection of malfunction is discussed as well as the consequences for adequate defibrillation therapy. An overview of the current published experience of intravascular extraction of ICD leads is provided including a brief discussion of our own experience.

From this overview we conclude that malfunctioning pace-sense or ICD leads can be left in situ if there are no uncovered insulation defects. Inserting a new pace-sense or ICD lead is preferable in this situation given the current known complication rate of lead extraction. Lead extraction should be reserved for damaged leads in which interference with proper detection or defibrillation of newly inserted leads cannot be excluded.