Does the risk-benefit analysis favor the extraction of failed, sterile pacemaker and defibrillator leads?

摘要

Transvenous pacemaker and defibrillator (PM-D) lead failure is an important clinical problem. Lead extraction is routinely performed in patients with transvenous pacemaker and defibrillator (PM-D) infections. The management of sterile PM-D leads that have failed or are no longer required is less uniform. While extraction of excess or failed sterile PM-D leads is often advocated, the risk of lead extraction must be weighed against the risk of abandoning these leads. There are no randomized trials comparing lead extraction with abandoning sterile leads in this setting. What then are the data that are used to advocate the extraction of excess or failed, sterile chronically implanted PM-D leads, and are the data adequate to make this recommendation?