ARRHYTHMIAS: Edited by David H. BirnieCardiovascular implantable electronic device lead extraction evidence, techniques, results, and future directionsSadek, Mouhannad M.a; Goldstein, Williama; Epstein, Andrew E.b; Schaller, Robert D.bAuthor Information aThe Ottawa Hospital, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, Ontario, Canada bThe Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Correspondence to Mouhannad M. Sadek, MD, The Ottawa Hospital, General Campus, 501 Smyth Road, PO Box 703, Ottawa, ON K1H8L6, Canada. Tel: +613 737 8135; fax: +613 739 6727; e-mail: [email protected] Current Opinion in Cardiology: January 2016 - Volume 31 - Issue 1 - p 23-28 doi: 10.1097/HCO.0000000000000247 Buy Metrics Abstract Purpose of review Cardiovascular implantable electronic devices are widely used to treat symptomatic arrhythmias, prevent sudden cardiac death, and improve symptoms and cardiac function. Continued population growth and expanding indications have resulted in a progressive increase in the number of cardiovascular implantable electronic device implantations. Mirroring this growth, an increasing number of leads require removal because of a variety of indications. Transvenous lead extraction continues to evolve with better techniques and risk-management strategies. This review highlights the indications, techniques, procedural outcomes, and future directions of arrhythmia device management and extraction. Recent findings Indications for extractions are reviewed in light of newly published data. Same day contralateral reimplantation has been shown to be safe in patients with localized pocket infection. Alternative extraction techniques, utilizing the femoral and internal jugular veins, provide additional routes for device removal as stand-alone procedures or in cases of difficult extraction via the subclavian vein. Preprocedural imaging to identify adherence sites and cardiac perforation can help to reduce complications. Routine capsulectomy at generator change does not seem to reduce the risk of device infection, and multiple trials are underway to assess other methods of reducing infections as part of a lead management strategy. Summary Improvement in technology, alternative routes of extraction and preprocedural imaging continue to add to procedural efficacy and reduce complication rates of lead extraction. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.