Establishing a Cardiac Implantable Electronic Device Lead Extraction Program in a Resource-Limited Setting

Abstract

Background

The rising number of cardiac implantable electronic device (CIED) implantations in Asia is expected to increase CIED-related infections and lead malfunctions. Establishing a lead extraction program is therefore essential. We describe the set-up and early implementation of the University of the Philippines-Philippine General Hospital (UP-PGH) Lead Extraction Program.

Methods

Data on preoperative, intraoperative, and postoperative management were collected, along with details on resources, personnel, and workflows. A descriptive analysis was performed.

Results

The UP-PGH Lead Extraction Program was launched on September 1, 2023. Key components-including personnel training, equipment procurement, hospital support, and workflow development-were successfully implemented. Within the first year, four procedures (eight leads) were completed (mean patient age: 60.75 years; lead dwell time: median of 6.2 years [IQR 10.15]; indication: infected pacemaker and ICD leads). All leads were completely removed without complications. The workflow included a structured preoperative process, including risk assessment, required investigations, antibiotic initiation, and subspecialty input. Intraoperative procedure included workflow optimization, materials readiness, and complication monitoring, which were prioritized during lead extraction. Post-procedure care involved completion of antibiotic treatment, culture processing, device reimplantation, and follow-up. These measures enabled safe lead removal by an electrophysiologist-led extraction team.

Conclusion

This successful launch of the UP-PGH Lead Extraction Program demonstrated that developing countries can feasibly establish such programs with well-defined workflows and adequate resource planning.