HRS Class I Indications for Extraction of Cardiac Leads

1. Complete device and lead removal is recommended in all patients with definite CIED system infection, as evidenced by valvular endocarditis, lead endocarditis or sepsis.
2. Complete device and lead removal is recommended in all patients with CIED pocket infection as evidenced by pocket abscess, device erosion, skin adherence, or chronic draining sinus without clinically evident involvement of the transvenous portion of the lead system.
3. Complete device and lead removal is recommended in all patients with valvular endocarditis without definite involvement of the lead(s) and/or device.
4. Complete device and lead removal is recommended in patients with occult gram-positive bacteremia (not containment).

HRS Class IIa Indications for Extraction of Cardiac Leads

1. Complete device and lead removal is reasonable in patients with persistent occult gram-negative bactermia.

HRS Class III Indications for Extraction of Cardiac Leads

1. CIED removal is not indicated for a superficial or incisional infection without involvement of the device and/or leads.
2. CIED removal is not indicated to treat chronic bacteremia due to a source other than the CIED, when long-term suppressive antibiotics are required.

HRS Class IIa Indications for Extraction of Cardiac Leads

1. Device and/or lead removal is reasonable in patients with severe chronic pain, at the device or lead insertion site, that causes significant discomfort for the patient, is not manageable by medical or surgical techniques and for which there is no acceptable alternative.

HRS Class I Indications for Extraction of Cardiac Leads

1. Lead removal is recommended in patients with clinically significant thromboembolic events associated with thrombosis on a lead or a lead fragment.
2. Lead removal is recommended in patients with bilateral subclavian vein or SVC occlusion precluding implantation of a needed transvenous lead.
3. Lead removal is recommended in patients with planned stent deployment in a vein already containing a transvenous lead, to avoid entrapment of the lead.
4. Lead removal is recommended in patients with superior vena cava stenosis or occlusion with limiting symptoms.
5. Lead removal is recommended in patients with ipsilateral venous occlusion preventing access to the venous circulation for required placement of an additional lead when there is a contraindication for using the contralateral side (e.g., contralateral AV fistula, shunt or vascular access port, mastectomy).

HRS Class IIa Indications for Extraction of Cardiac Leads

1. Lead removal is reasonable in patients with ipsilateral venous occlusion preventing access to the venous circulation for required placement of an additional lead, when there is no contraindication for using the contralateral side.

HRS Class I Indications for Extraction of Cardiac Leads

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).

HRS Class IIb Indications for Extraction of Cardiac Leads

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., Teletronics 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 specific imaging techniques (e.g., MRI) that cannot 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.

HRS Class III Indications for Extraction of Cardiac Leads

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.

HRS Class I Indications for Extraction of Cardiac Leads

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).

HRS Class IIa Indications for Extraction of Cardiac Leads

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 specific imaging techniques (e.g., MRI) and cannot be imaged due to the presence of the CIED system for which there is not other available imaging alternative for the diagnosis.

HRS Class IIb Indications for Extraction of Cardiac Leads

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.

HRS Class III Indications for Extraction of Cardiac Leads

1. Lead removal is not indicated in patients with non-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.