| Pocket infection with or without bacteraemia |
Localised signs of inflammation such as erythema, swelling, pain, tenderness, warmth or drainage with positive or negative blood cultures |
| Left-sided endocarditis in a CIED carrier |
Left heart vegetations with or without tricuspid valve or CIED involvement, and positive blood cultures |
| CIED-related endocarditis |
Positive blood cultures and lead or valvular vegetation(s), without local signs of pocket infection |
| Occult bacteraemia with probable CIED infection |
Bacteraemia without an alternative source, resolves after CIED extraction |
| Non-infectious |
Clinical Scenarios (Class I, IIa, And IIb Indications) |
| Thrombosis/vascular Issues |
Clinically significant thromboembolic events attributable to thrombus on a lead or a lead fragment that cannot be treated by other means (class I) |
|
Superior vena cava (SVC) stenosis or occlusion that prevents implantation of a necessary lead (class I) |
|
Planned stent deployment in a vein already containing a transvenous lead to avoid entrapment of the lead (class I) |
|
Maintaining patency of SVC stenosis or occlusion with limiting symptoms (class I) |
|
Ipsilateral venous occlusion preventing access to the venous circulation for required placement of an additional lead (class IIa) |
| Chronic pain |
Severe chronic pain at the device or lead insertion site or believed to be secondary to the device, which causes significant patient discomfort, is not manageable by medical or surgical techniques, and for which there is no acceptable alternative[17] (Class IIa) |
| Other |
Life-threatening arrhythmias secondary to retained leads (class I) |
|
Lead removal can be useful for patients with a CIED location that interferes with the treatment of a malignancy[18] (class IIa) |
|
CIED implantation requires more than four leads on one side or more than five leads through the SVC (class IIa) |
|
Abandoned lead(s) that interfere with the operation of a CIED system (class IIa) |
|
Leads that pose a potential future threat to the patient if left in place, because of their design or failure (class IIb) |
|
Lead removal may be considered to facilitate access to MRI[18] (class IIb) |
|
The setting of normally functioning, non-recalled pacing or defibrillation leads for selected patients after a shared decision-making process (class IIb) |
