How to prevent, recognize, and manage complications of lead extraction. Part II: Avoiding lead extraction--noninfectious issues.

摘要

The first part of this review examined the infectious indications for lead extraction. This part discusses noninfectious indications for lead extraction and strategies for reducing the incidence of such indications. At some centers, nonfunctional (abandoned) leads are removed at the time of new lead placement, with the rationale that they may result in future complication1'2 and require removal when extraction would be more difficult.3'4 In the absence of symptoms of vascular obstruction, we are comfortable with patients having up to five leads in the superior vena cava, if necessary (Figure 1). We believe that the risks of extraction in many cases outweigh the benefit, especially in elderly patients or those with only a small number of leads in place. In elderly patients, single nonfunctional lead is a class III indication for extraction.5 However, in young patients with a normal life expectancy, a case-by-case approach is used for management of abandoned leads. In our practice, many of these leads are extracted.