Contemporary pacemaker and ICD lead management: techniques for lead extraction

With the increasing utilization of cardiac implantable electronic devices, the ability to extract leads using the transvenous approach has become important. Devices that are infected and leads that pose a risk to the patient by causing damage to cardiovascular structures, interference with device function or life-threatening arrhythmias should be removed. While the majority of extractions are performed through the vein of implantation, other approaches, such as the femoral approach, are required in some circumstances. Simple traction may be successful in removing the lead in relatively new (<1 year) implants. Older devices invariably require devices such as locking stylets and simple or powered sheaths. With current techniques, complete lead extraction can be achieved in >90% of cases with a major complication rate of <2% and mortality rate of <1%. Transvenous lead extraction should be performed only by experienced operators with the resources to address life-threatening complications.