NON FUNCTIONAL LEADS
Class I
1. Lead removal is recommended in patients with life threatening arrhythmias secondary to retained leads or lead fragments.
(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 IIa
1. Lead removal is reasonable in patients with leads that due to their design or their failure pose a threat to the patient, that is
not immediate or imminent if left in place. (e.g. Telectronics ACCUFIX without protrusion) (Level of evidence C)
2. Lead removal is reasonable in patients if a CIED implantation would require more than 4 leads on one side or more than 5
leads through the SVC. (Level of evidence C)
3. Lead removal is reasonable in patients that require speciļ¬c imaging techniques (e.g. MRI) and 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)
Class IIb
1. Lead removal may be considered at the time of an indicated CIED procedure, in patients with non-functional leads, if
contraindications are absent. (Level of evidence C)
2. Lead removal may be considered 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 non-functional 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)