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EHRA Key References on Lead extraction

Latest update 2013 December

Device Therapy
Device Complications and Lead Extraction
Arrhythmias and Device Therapy


Transvenous Lead Extraction: Heart Rhythm Society Expert Consensus on Facilities, Training, Indications, and Patient Management.
Wilkoff et al. Heart Rhythm. 2009 Jul;6(7):1085-104.
This consensus statement outlines patient management and indications for lead extraction.

Pathways for training and accreditation for transvenous lead extraction: a European Heart Rhythm Association position paper.
Deharo et al. Europace (2012) 14, 124–134.
This position paper outlines the training requirements for performing a lead extraction.

Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.
Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB,
Masoudi FA, Okum EJ, Wilson WR, Beerman LB, Bolger AF, Estes NA 3rd, Gewitz M,
Newburger JW, Schron EB, Taubert KA; American Heart Association Rheumatic Fever,
Endocarditis, and Kawasaki Disease Committee; Council on Cardiovascular Disease
in Young; Council on Cardiovascular Surgery and Anesthesia; Council on
Cardiovascular Nursing; Council on Clinical Cardiology; Interdisciplinary Council
on Quality of Care; American Heart Association.
Circulation. 2010 Jan 26;121(3):458-77.

"Recognizing the recent advances in our understanding of the epidemiology, risk factors, microbiology, management, and prevention of CIED infections, the American Heart Association commissioned this scientific statement to educate clinicians about CIED infections, provide explicit recommendations for the care of patients with suspected or established CIED infections, and highlight areas of needed research".

Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).
The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and by the International Society of Chemotherapy (ISC) for Infection and Cancer.
European Heart Journal (2009) 30, 2369–2413

A European perspective on lead extraction: part I.
Kennergren C. Heart Rhythm.2008 Jan;5(1):160-2.Review. 

European perspective on lead extraction: part II.
Kennergren C. Heart Rhythm. 2008 Feb;5(2):320-3.

Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads.
Bongiorni MG, Soldati E, Zucchelli G, Di Cori A, Segreti L, De Lucia R, Solarino G, Balbarini A, Marzilli M, Mariani M.

Eur Heart J. 2008 Dec;29(23):2886-93. 

"The importance of transvenous lead removal techniques is currently increasing due to the rapidly rising number of implanted devices. The use of a single sheath method for freeing binding sites and the use of the internal transjugular approach increased the effectiveness of mechanical dilatation while avoiding the costs related to the use of powered sheaths. This technique reduces the incidence of serious complications, which can lead in turn to expanded indications for transvenous lead removal.”

Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial.
Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf R, Parsonnet V,
Epstein LM, Sorrentino RA, Reiser C.

J Am Coll Cardiol. 1999 May;33(6):1671-6.

The purpose of this study was to evaluate the safety and effectiveness of pacemaker lead extraction with the early laser excimer sheath in comparison to nonlaser lead extraction.

Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions.

Wazni O, Epstein LM, Carrillo RG, Love C, Adler SW, Riggio DW, Karim SS,
Bashir J, Greenspon AJ, DiMarco JP, Cooper JM, Onufer JR, Ellenbogen KA, Kutalek
SP, Dentry-Mabry S, Ervin CM, Wilkoff BL.
J Am Coll Cardiol. 2010 Feb 9;55(6):579-86.

Lead extraction employing new laser sheaths is highly successful with a low procedural complication rate.

Deaths and cardiovascular injuries due to device-assisted implantable cardioverter-defibrillator and pacemaker lead extraction.
Hauser RG, Katsiyiannis WT, Gornick CC, Almquist AK, Kallinen LM. 

Europace. 2010 Mar;12(3):395-401. 

Device-assisted lead extraction can be a high-risk procedure and that serious complications including death may not be mitigated by emergency surgery. However, skilled standby cardiothoracic
surgery is essential when performing pacemaker and ICD lead extractions. Although the incidence of these complications is unknown, the results of the study imply that device-assisted lead extractions should be performed by highly qualified physicians and their teams in specialised centres.

Continued rise in rates of cardiovascular implantable electronic device infections in the United States: temporal trends and causative insights.
Voigt A, Shalaby A, Saba S.
Pacing Clin Electrophysiol . 2010 Apr;33(4):414-9. 

"The number of patients with CIED-related infections in the United States continues to increase out of proportion to the increase in implantation rates. Possible causes for this ongoing epidemic include sicker patients with varying racial backgrounds and more complex procedures. These insights may help improve our ability to best select patients for CIED implantation in "real-life" settings".

Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study.
Udo EO, Zuithoff NP, van Hemel NM, de Cock CC, Hendriks T, Doevendans PA, Moons KG. 

Heart Rhythm. 2012 May;9(5):728-35. 

« Complication incidence in modern pacing therapy is still substantial. Most complications occur early after PM implantation. Although various patient- and procedure-related characteristics are independent predictors for early and late complications, their ability to identify the patient at high risk is rather poor. This relatively high incidence of PM complications and their poor prediction underscores the usefulness of current guidelines for regular follow-up of patients with PM».