Contemporary Pacemaker and ICD Lead Management

Techniques for Lead Extraction

Malini Madhavan; Matthew J Swale; Joseph J Gard; David L Hayes; Samuel J Asirvatham


Expert Rev Cardiovasc Ther. 2012;10(7):875-887. 

In This Article

Abstract and Introduction


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.


With the increasing indications for cardiac implantable electronic device (CIED; including pacemaker, implantable cardioverter-defibrillator [ICD] and cardiac resynchronization therapy) implantation, and the reported failure rates of various types of leads as well as infection rates, the ability to remove infected, failing or redundant systems as safely and effectively as possible is of increasing importance. From the earliest approaches, where a simple weight or pulley system was applied to the end of the lead and left for hours or days to slowly separate fibrotic tissue, to the advent of dissecting sheaths with assisting energy sources, the application of advancing technology has increased success rates for complete removal of leads; however, the complication rates remain relatively unchanged.