Table 2

Indications for pacemaker lead extraction

Systemic infection or pacemaker lead related endocarditis: primary lead extraction
Local infection: primary lead extraction. Consider conservative treatment if only low grade infection or skin erosion present; in case of recurrence extract leads
Non-functional leads
Patent venous system: abandon dysfunctional leads, insert new leads ipsilaterally
Occluded venous system: extraction of a non-functional lead and insertion of new leads through exchange procedure ipsilaterally
Thrombotic complications
Vena cava superior syndrome: consider extraction of non-functional lead and dilatation and stenting of vena cava obstruction
Pulmonary emboli: oral anticoagulation, lead extraction only if embolisation persists
Accufix and Encor leads
Intact retention wire: serial fluoroscopy
Suspected fracture: lead extraction if longer life expectancy and low risk of extraction, else serial fluoroscopy
Protruding or migrated retention wire: lead extraction, if high risk of extraction decide on case by case basis
Chronically implanted left ventricular endocardial leads: anticoagulation, surgical extraction if recurrent embolisation
Lead related tricuspid valve insufficiency: no proven benefit of lead extraction