From lead management to implanted patient management: indications to lead extraction in pacemaker and cardioverter–defibrillator systems

Based on the published results primarily from cohort studies, percutaneous lead extraction is now considered a safe procedure and indications for its use have broadened from device-related infections to less strict indications, such as recurrent isolated bacteremia, asymptomatic upper vein occlusion and malfunctioning/redundant leads. Almost 50% of electrophysiologists consider lead extraction in these latter situations. To broaden its implementation, further prospective evaluation against conservative approaches is still needed. Rather than only aiming at short-term results, this technique should be integrated into wide-ranging tailored long-term strategies to manage all of the different issues of implanted patients.