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

Lead failure in cardiac implantable electronic devices (CIEDs) presents a critical challenge in clinical electrophysiology. These failures can result in inappropriate therapies, ineffective pacing, and even life-threatening outcomes. Despite technological advances in device design, transvenous leads remain an important source of complications.

Novel developments in lead extraction strategies including pre-procedure risk prediction instruments, estimation of short-term mortality after lead extraction procedure, use of new technologies including shock-wave lithotripsy to facilitate disruption of intravascular calcium, cardioneural ablation to avoid need for reimplantation of cardiac devices, and the use of leadless pacemaker/defibrillator systems followed transvenous extraction are discussed. This review explores the underlying mechanisms of lead failure, highlighting notable cases such as the Riata and Fidelis recalls, and discusses the complex decision-making process surrounding lead abandonment, extraction, or replacement.