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Lead Extraction Risks — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionLead Extraction RisksSCE Infectious Diseases

A 50-year-old man with a pacemaker develops Staphylococcus aureus bacteraemia. TOE shows a 1.2 cm vegetation on the pacemaker lead. The cardiology team recommends lead extraction under cardiothoracic surgical cover. What is the main risk of percutaneous lead extraction?

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Correct answer: E — Lead extraction can cause cardiac/vascular injury (tricuspid valve damage, SVC laceration, cardiac tamponade) — it must be performed in a centre with immediate cardiothoracic surgical backup

Percutaneous transvenous lead extraction (TLE) carries risks of: tricuspid valve damage (the lead passes through the valve), superior vena cava laceration (adhesions between lead and vessel wall), cardiac perforation, tamponade, and pulmonary embolism from dislodged vegetation. Mortality is 0.5–1%. Therefore, TLE for infected CIED should ONLY be performed in specialist centres with immediate cardiothoracic surgical backup and with a cardiac surgeon on standby. The AHA 2024 statement emphasises the importance of institutional experience and surgical backup.

Reference: AHA 2024 – CIED infection; HRS 2017 – Lead management