FUNCTIONAL LEADS

Class I
1. Lead removal is recommended in patients with life threatening arrhythmias secondary to retained leads.

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).

3. Lead removal is recommended in patients with leads that interfere with the operation of implanted cardiac devices.

4. Lead removal is recommended in patients with leads that interfere with the treatment of a malignancy (radiation/reconstructive surgery).

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.

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)

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)

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.

5. Lead removal may be considered in patients in order to permit the implantation of an MRI conditional CIED system.

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.

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.



Heart Rhythm, Vol 6, No 7, July 2009.