Device Extractions
Implantation rates of pacemakers and implantable cardioverter-defibrillators (ICDs) have increased over time. Unfortunately, the infection rate with cardiovascular implantable electronic devices (CIEDs) has also increased over time because of device implantation in older patients with more comorbidities. Device infections are the most common reason for lead removal, while the second most common reason is lead failure. An electrocardiogram is needed prior the procedure. This determines some of the followings: the presence of valvular lesions, tricuspid regurgitation, a baseline pericardial effusion, exclusion of a patent foramen ovale or atrial septal defect that could result in paradoxical embolism during lead extraction, and ejection fraction. Patients with left bundle branch blocks are at risk for complete heart block during the extraction procedure, in the event that the right bundle branch block secondary to catheter manipulation is encountered.
