Abstract
Pacemaker and ICD leads have complex compound designs and are therefore the weakest link in cardiac rhythm device therapy. Technical problems are mostly insulation defects. Their number increases during follow-up and makes up more than 50 percent of the yearly failure rate of up to 20% after ten years of service life. Design flaws of specific lead models need special management. The implanting physician is first confronted with anatomic barriers to lead introduction, but his technique also impacts the hardware's failure rate, and his training and procedure volume are predictive of the dislodgment risk, the need for revision and, eventually, infection. Every potential hardware contamination urges complete removal of the system. Early explantation improves prognosis. First choice is transvenous lead extraction which achieves high success rates even with left heart leads but also has specific risks of complications.
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