Explant Procedures

Abstract

The important indications for removal of a pacemaker, CRT device, or ICD are shown in Table 19.1. The most frequent reason is infection of the pacing system (see Figs. 12.31 and 12.32). Erosion of leads (see Fig. 12.69) or pacemakers (Fig. 12.71) through the skin and associated sepsis has become less of a problem as the devices have become smaller and more ovoid and the leads softer. The techniques of careful asepsis and burying the generator deep in a prepectoral or subpectoral pocket away from the skin have resulted in lowering the incidence of infection and erosion. However, ICDs are still large and infection/erosion will more commonly occur with these devices unless care is taken to avoid the causal factors. Elderly, frail and thin patients are more at risk of infection and erosion, as are those who develop hematoma in the pocket necessitating drainage.