Cardiac Leads: When Should They Be Removed?

Patients with underlying cardiovascular disease are living longer than ever. That’s the great news. What’s not so great? Living longer means heart disease patients with ICDs and pacemakers are seeing more long-term problems with their cardiac leads and devices.

From lead breakdown to vascular occlusion to infection, many problems can lead to the need to remove or replace cardiac leads. Current indications for lead removal include:

• Cardiac lead advisory with high-risk failure rate
• Device pocket infection
• Cardiac lead endocarditis
• Unexplained bacteremia in a patient with an existing device:
  • Gram positive bacteremia (Class I indication)
  • Gram negative bacteremia (Class IIa indication)

• Vascular occlusion:
  • Symptoms of SVC occlusion
  • Prior to planned venous stenting (to avoid lead entrapment)
  • Needed lead revision or device upgrade

• Need for MRI conditional device with no alternate imaging options

Nationally Recognized in Lead Extraction

Sanger Heart & Vascular Institute is a nationally recognized leader in cardiac rhythm device laser and mechanical lead extraction.

Using a full complement of lasers and mechanical tools, including femoral venous approaches, Sanger’s lead extraction program uses a multidisciplinary approach with collaboration among our electrophysiology, cardiac imaging and cardiothoracic surgery teams.

We use a novel cardiac CT-based risk stratification approach to help you and your patients choose the optimal method to fit their cardiac device management needs.

Over the past 10 years, the program has served over 500 patients and managed over 1,000 leads, realizing a 0% intraoperative mortality with a 100% clinical success rate and an average lead age of 9 years.

Considerations for high-risk referrals include patients with:

• Multiple leads (4 or more) through central veins
• Clinical evidence (surface collaterals) of venous occlusion
• Younger age at implant (age <40)
• Longer lead dwell time (pacemaker leads>10 years; ICD leads > 5 years)

Advancing Care Through Clinical Trials & Research

We’re an active participant in national and investigator-initiated research, and one of just eight centers nationally in the BRIDGE balloon occlusion trial, which is evaluating the use of an occlusion balloon within the superior vena cava in lead extraction patients.

Consult With Our Experts Today

For a consultative opinion regarding lead management or for consideration of cardiac CT to define your patient's lead management risk, call 704-373-0212.