FUNCTIONAL LEADS
Class I
1. Lead removal is recommended in patients with life threatening arrhythmias secondary to retained leads. (Level of evidence: B)
2. Lead removal is recommended in patients with leads that, due to their design or their failure, may pose an immediate threat
to the patients if left in place. (e.g. Telectronics ACCUFIX J wire fracture with protrusion). (Level of evidence: B)
3. Lead removal is recommended in patients with leads that interfere with the operation of implanted cardiac devices. (Level of
evidence: B)
4. Lead removal is recommended in patients with leads that interfere with the treatment of a malignancy
(radiation/reconstructive surgery). (Level of evidence: C)
Class IIb
1. Lead removal may be considered in patients with an abandoned functional lead that poses a risk of interference with the
operation of the active CIED system. (Level of evidence: C)
2. Lead removal may be considered in patients with functioning leads that due to their design or their failure pose a potential
future threat to the patient if left in place. (e.g. Telectronics ACCUFIX without protrusion) (Level of evidence: C)
3. Lead removal may be considered in patients with leads that are functional but not being used. (i.e. RV pacing lead after
upgrade to ICD) (Level of evidence: C)
4. Lead removal may be considered in patients who require speciļ¬c imaging techniques (e.g. MRI) that can not be imaged due to the
presence of the CIED system for which there is no other available imaging alternative for the diagnosis. (Level of evidence: C)
5. Lead removal may be considered in patients in order to permit the implantation of an MRI conditional CIED system. (Level of
evidence: C)
Class III
1. Lead removal is not indicated in patients with functional but redundant leads if patients have a life expectancy of less than
one year. (Level of evidence: C)
2. Lead removal is not indicated in patients with known anomalous placement of leads through structures other than normal
venous and cardiac structures, (e.g. subclavian artery, aorta, pleura, atrial or ventricular wall or mediastinum) or through a
systemic venous atrium or systemic ventricle. Additional techniques including surgical backup may be used if the clinical
scenario is compelling. (Level of evidence: C)