NON-FUNCTIONAL LEADS

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

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 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).

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.

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.

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.

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

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.

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.