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Cardiac implantable electronic device lead removal

Ann C Garlitski, MD, FACC, FHRS
Section Editor
Brian Olshansky, MD
Deputy Editor
Brian C Downey, MD, FACC


As more people are living longer with more significant cardiac disease, permanent pacemakers (PPMs) and implantable cardioverter-defibrillators (ICDs) are being inserted more frequently. Beginning early in the 21st century, there has also been an expansion in the indications for cardiac implantable electronic devices (CIED, a term which includes PPMs and ICDs), and device therapy has become more complex, frequently involving multiple leads per patient. As such, there are occasions when it is necessary to remove a device and any associated leads.

The most common indications for lead removal are infection, venous occlusion, advisory or recall as a result of (potential) lead malfunction, or mechanical lead failure. Lead management involves the assessment of risks and benefits of whether or not to remove the lead based on the individual clinical condition of the patient as well as lead characteristics.

This topic will discuss the indications for lead removal, lead removal procedure requirements, outcomes, and potential complications of lead removal. A more comprehensive discussion of CIED infection, complications of CIED implantation, and device malfunction is found separately. (See "Infections involving cardiac implantable electronic devices" and "Implantable cardioverter-defibrillators: Complications" and "Pacing system malfunction: Evaluation and management".)


Standardized definitions related to lead removal have been proposed [1]. Lead removal is a general term which encompasses removal of a cardiac implantable electronic device (CIED) lead using any technique, while lead explantation and lead extraction are terms with more specific definitions.

Lead explantation – Lead explantation is defined as removal of a lead that has been implanted for less than one year via the implant vein using only the tools typically supplied for lead implantation in combination with manual traction.


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Literature review current through: Sep 2016. | This topic last updated: Feb 11, 2016.
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