Cardiovascular Implantable Electronic Device Lead Management and Extraction
Key Points
Key Points
- Over the past 60 years, CIEDs have become established as an important therapeutic modality of cardiovascular care for the treatment of patients with bradycardia, tachycardia, and heart failure.
- Although recent technological advances have eliminated the need for transvenous or epicardial leads for CIEDs used in selected groups of patients, lead management remains critical for a variety of reasons.
- Recent estimates suggest that 1.2–1.4 million CIEDs are implanted annually worldwide.
- Questions on lead management arise in a number of situations, including when changes in a patient’s clinical condition make a different functionality more or less important, if a lead becomes nonfunctional, and if the presence of a lead is thought to interfere with the patients' optimal treatment.
Diagnosis
Diagnosis
...focus is on ICD leads due to their higher failure...
...itionsHaving trouble viewing table? Expand...
Treatment
...eatment
Lead Survival
...model and clinical scenario-specific s...
...sting CIED Lead Management...
...aving the lead in a condition that will perm...
...ideration with the patient on the dec...
...d abandonment or removal can be a useful...
...D Infection...
...antibiotics are going to be prescribed,...
...tain and culture of generator pocket tissue and th...
...ransesophageal echocardiography is recommended fo...
...aluation by physicians with specific expertise in...
...sophageal echocardiography can be useful for patie...
...physicians with specific expertise in CIED infec...
...l imaging may be considered to faci...
...rse of antibiotics based on identificati...
...vice and lead removal is recommended for all pati...
...removal of epicardial leads and patches is r...
...evice and lead removal is recommended for all...
...evice and lead removal is recommende...
...consideration of the implications of other impla...
...isk Factors for CIED InfectionHaving tr...
...ns for Lead Extraction (Noninfectious)...
...vice and/or lead removal can be useful...
...is recommended for patients with clinically si...
...recommended for patients with SVC s...
...ad removal is recommended for patients with plann...
...removal as part of a comprehensiv...
...l can be useful for patients with ipsilatera...
...recommended for patients with life-threat...
...be useful for patients with a CIED...
...al can be useful for patients if a CIED i...
...emoval can be useful for patients with a...
...d removal may be considered for patients with lea...
...ad removal may be considered for pati...
...ead removal may be considered in the...
Periprocedural Man...
...tory Phase Perform a comprehensive history and...
...es and Follow-up...
...n programs and operator-specific inf...
Table 3. Lead Abandonment Clinical...
...Associated with Extraction Procedur...
...le 5. Extraction Procedure-Related ComplicationsH...
...1. Management of Suspected CIED Infection...
...anagement of Suspected Pocket Infection
.... Management of Bacteremia without Evidence of...