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The right setup and a team approach are critical to successful removal of cardiac device transvenous leads, says , director of pacemaker and ICD services at the University of California San Diego.
In this exclusive video, she describes her center's lead removal program team approach with cardiac electrophysiologists, cardiothoracic surgeons, cardiac anesthesiologists, infectious diseases specialists, and the operating room team.
A transcript follows:
We know that about 700,000 new pacemakers and defibrillators are implanted worldwide every year, and about 1.4 million leads are placed. Of course, the overwhelming majority of these devices will work very well for those patients, but there are times when the leads will need to be replaced or extracted. It's estimated that about 10,000 to 15,000 leads will need to be extracted worldwide every year. About 50% of those extractions are done for infections, but there are other indications as well, and these indications are perhaps expanding. They would include malfunctioning leads, extractions done in the setting of device upgrades, or extractions done when you need to place leads in a scenario of venous occlusion and the need for vascular access.
And as all implanters know, we know it's easier to put leads in than it is to take those leads out. So, having the right setup to be able to correctly do lead extractions -- and safely do lead extractions -- is incredibly important. What it really comes down to is the team and the tools.
At UCSD, we have been champing the team approach. We have about 500 cases now where we have successfully put a team in place, where we involve our cardiac electrophysiologists, cardiothoracic surgeons, cardiac anesthesiologists, infectious disease colleagues, the OR team, where everyone is on the same page, involved in the case, and understand what's going on. When we get to that point, that's really where we can say that we have successfully managed to setup a lead extraction program. But also, most importantly, this is how we can safely do the lead extractions so that every patient can benefit.