Engineering Principles of Lead Extraction

It is critical to consider future removal of any device implanted within the human cardiovascular system. Techniques for removal of cardiac implantable electronic device (CIED) leads have grown primarily through an experiential approach. This chapter defines engineering considerations for the extraction procedure. The goal is to provide engineering insights to assist current and future extractors and to lay a foundation for development of new tools and techniques. Basic principles of CIED lead construction are reviewed including individual unique lead characteristics, as well as the technique and importance of creating an extraction rail. Once created, we describe how best to use that rail from either a subclavian or femoral approach. The extractor must understand the angle of approach, technique, and stresses that leads are exposed to when implanted within the harsh environment of the human body, as well as individual operator implant preference. Biological models (cadaver, animal, and pathologic) can be used to (1) understand these stresses and the process of extraction; (2) teach current extraction techniques; and (3) develop new tools and techniques. Leadless pacers are the latest advancement in intracardiac pacing devices that require a unique set of tools and approaches for removal.