The Implantation of New Leads after Extraction

The natural consequence of lead extraction procedures is the need for a subsequent device reimplantation. For this reason, when an extraction procedure is planned, the patient should be aware of the potential risks and complications related to both procedures and should be informed of potential alternatives in case of transvenous reimplantation failure. Reimplantation is not necessary in all the patients. The need for reimplantation after lead extraction cannot be always predicted before pac-ing/defibrillating system removal. In previous published studies, reimplantation rate has been reported to vary from 48% to 87% of cases [1-3] in our experience, according with other centers, reimplantation of a new device is usually not required in about 20% of patients [4, 5]. However, in all patients undergoing lead extraction, especially in case of previous infection, the ongoing need of a cardiac device should be reassessed [6]. 

The indication for the extraction can explain different reimplantation settings. Generally, two different scenarios can be described patients with a cardiovascular implantable electronic device (CIED) infection and patients with a malfunctioning lead. Moreover, in the era of cardiac resynchronization therapy (CRT), a specific skill in biventricular device reimplantation is required in large-volume centers and will be described separately. 

2nd Cardiovascular Department AOUP, Santa Chiara University Hospital, Pisa, Italy 

Bongiomi (Ed.), Transvenous Lead Extraction. Springer-Verlag Italia 2011 

Some authors recommend contralateral reimplantation as early as 36 h after extraction in patients with local symptoms only of device-related infection [10]. In some instances, it is considered safe to perform a contralateral same-day reimplantation [11]. The reasons for a same-day reimplantation are usually pacemaker (PM) dependency or hemodynamic need for CRT in case of biventricular pacing. In fact, the risk of subsequent CIED infections and venous thrombosis increases while maintaining a transvenous temporary device, and for this reason, it cannot be used indefinitely [12]. Same-day reimplantation is considered safe if the patient is clinically proven not to have active systemic bacteremia or infection by blood culture at the time of extraction and there is a lack of transesophageal echocardiographic evidence for endocarditis and the presence of a normal white blood cell count. 

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The typical indication to reimplantation in absence of infection is PM/defibrillator lead malfunction. Other possible causes are reimplantation after extraction due to a superior vena cava (SVC) syndrome or need for new lead implantation in case of venous occlusion. 

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