Indications for pacemaker lead extraction
| Infection |
| 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 |
| Miscellaneous |
| Chronically implanted left ventricular endocardial leads: anticoagulation, surgical extraction if recurrent embolisation |
| Lead related tricuspid valve insufficiency: no proven benefit of lead extraction |