THROMBOSIS OR VENOUS STENOSIS
Class I
1. Lead removal is recommended in patients with clinically significant thromboembolic events associated with thrombus on a lead or a lead fragment.
2. Lead removal is recommended in patients with bilateral subclavian vein or SVC occlusion precluding implantation of a needed transvenous lead.
3. Lead removal is recommended in patients with planned stent deployment in a vein already containing a transvenous lead, to avoid entrapment of the lead.
4. Lead removal is recommended in patients with superior vena cava stenosis or occlusion with limiting symptoms.
5. Lead removal is recommended in patients with ipsilateral venous occlusion preventing access to the venous circulation for required placement of an additional lead when there is a contraindication for using the contralateral side (e.g. contralateral AV fistula, shunt or vascular access port, mastectomy).
Class IIa
1. Lead removal is reasonable in patients with ipsilateral venous occlusion preventing access to the venous circulation for required placement of an additional lead, when there is no contraindication for using the contralateral side.
Heart Rhythm, Vol 6, No 7, July 2009.