[Pacemaker and defibrillator lead extraction techniques - literature review and own results]

In the past, the application of continuous traction used to be the alternative to open surgical removal of impacted pacemaker leads. Today's state-of-the-art methods for lead extraction follow the principles of traction (by locking stylets) and countertraction (by outer sheaths). Technical advances with respect to outer sheath design - including the use of lasers or bipolar electrocautery - led to a higher success rate, particularly as far as the removal of endocardial defibrillator leads is concerned.    From 1997 to 1999, we treated 31 patients (pts) who required lead extraction more than 6 months after lead implantation. In 16 pts pacemaker leads and in 15 pts endocardial defibrillator leads had to be removed. All but one infected lead could be extracted using the "Cook-Byrd-Method" described here. Incompletely extracted leads were more common in the patient group without infection. This may be the result of different levels of "aggressiveness" when removing leads in infected and non-infected cases, and a reflection of the different risks.    We report on the technical principles of lead removal. Published methods and results are reviewed and compared. The laser sheath, recently favored by some authors, are not necessarily quicker, better and safer. New electrosurgical dissection sheaths seem to be promising in one study with just a small sample size. The results of the EXCL study (Electrosurgical Extraction of Cardiac Leads) will provide us with new data. Complete lead removal is mandatory, especially in systemically infected pacemaker systems, while it remains most important to prevent harm to the individual patient. The "aggressiveness" of each procedure should be related to the potential risk. However, the costs associated with each method may not be neglected.