To Extract or not To Extract? Navigating Lead Failure in Cardiac Devices.

Area of Science:

• Cardiovascular Medicine
• Electrophysiology
• Biomedical Engineering

Background:

• Lead failure in cardiac implantable electronic devices (CIEDs) poses significant clinical challenges.
• Failures can lead to inappropriate therapies, ineffective pacing, and life-threatening events.
• Transvenous leads, despite advancements, remain a common source of CIED complications.

Purpose of the Study:

• To review novel developments in lead extraction strategies for CIEDs.
• To explore mechanisms of lead failure and discuss management decisions.
• To highlight recent technological advancements in managing lead complications.

Main Methods:

• Review of current literature on CIED lead failure and extraction.
• Discussion of novel technologies and risk prediction instruments.
• Analysis of decision-making processes for lead abandonment, extraction, or replacement.

Main Results:

• Novel strategies include pre-procedure risk prediction and short-term mortality estimation.
• New technologies like shock-wave lithotripsy and cardioneural ablation are discussed.
• The use of leadless systems following transvenous extraction is explored.

Conclusions:

• Advances in lead extraction strategies and technologies are crucial for managing CIED lead failures.
• Effective risk prediction and utilization of new tools can improve patient outcomes.
• Careful decision-making regarding lead management is essential in clinical electrophysiology.