LEADconnection

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Display name	LEADconnection
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Member since	September 17, 2022
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Topics Started
- Understanding the Conduction System: A Foundation for Modern Pacing Strategies
  January 7, 2026
- Surgical Backup in Lead Extraction: A Conversation Between EP & Cardiac Surgery
  December 2, 2025
- Balancing Extraction vs. Conservative Management
  November 3, 2025
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- Thank you for your questions. Responses are below from both Shinya Unai and Tom Callahan: 1. How can surgeons be “motivated” to provide this service? It is perceived as a not very gratifying service to provide (it is always messy, often times at goofy hours, incorporated into already busy schedules, or simply different of clinical judgment). Shinya Unai, M.D.: This is a good question and varies from one institution to another. In our institution, our surgeons are able to cover extractions on their call days. In others, backing up extractions counts toward quality improvement work for salaried surgeons. In other programs, surgeons will double scrub. 2. in those cases where either the Patient refuses or the surgeon feels that rescue is not appropriate, what is your discussion like with the patient as far as informed consent for what is felt to be an indicated procedure going on without rescue, and what would be your plans or interventions that stop just short of rescue sternotomy in the case of laceration? Tom Callahan, M.D.: I've not had a patient refuse back up. There have been cases that our surgeons review and feel surgical rescue would be futile in the event of a major cardiac or vascular complication during TLE. If extraction is a class 2 indication for the patient, we review options an typically pursue an option that does not involve TLE. If the patient is infected, we review risks of major complications and note that a major cardiac or vascular complication would be fatal without backup. We also discuss options of chronic suppression and palliative options. In most cases of infection where back up is deemed futile, the patient still opts for extraction. In those cases, I still prep the Bridge Balloon and proceed as if back up were available. There are some bleeding complications from TLE that develop slowly and can be temporized with the balloon or a drain. In such a case, once stabilized, I would likely call the CT surgeon in to discuss again. (posted by Administrator - LEADconnection)
  December 22, 2025
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