2026 HRS/AHA/APHRS/EHRA/IDSA/LAHRS/PACES/STS Expert Consensus Statement Update on Cardiovascular Implantable Electronic Device Lead Management and Extraction

April 23, 2026—The Heart Rhythm Society (HRS) released the 2026 HRS/AHA/APHRS/EHRA/IDSA/LAHRS/PACES/STS Expert Consensus Statement Update on Cardiovascular Implantable Electronic Device Lead Management and Extraction, providing updated, comprehensive guidance on the management and extraction of cardiovascular implantable electronic device (CIED) leads.

CIED lead management remains a complex and evolving area of cardiovascular care, with increasing device utilization, longer patient lifespans, and growing clinical scenarios requiring lead revision or extraction. This update reflects advances in technology, expanded operator experience, and new evidence that have emerged since prior guidance.

The document provides practical, multidisciplinary recommendations spanning the full spectrum of lead management—from decision-making around lead abandonment versus extraction to procedural planning, execution, and post-procedural care. Emphasis is placed on patient selection, procedural safety, and team-based care, recognizing the inherent risks associated with lead extraction.

Key areas addressed include:

• Indications for lead extraction, including infection, lead malfunction, vascular complications, and system upgrades
• Risk-benefit assessment and shared decision-making for lead abandonment versus removal
• Preprocedural planning, including imaging strategies and risk stratification
• Best practices for procedural techniques and technologies, including specialized extraction tools
• The role of multidisciplinary extraction teams and institutional readiness
• Management of complications and strategies to improve procedural safety
• Post-extraction care and longitudinal patient management

The update underscores the importance of performing lead extraction in appropriately equipped centers with experienced operators and surgical backup, given the potential for life-threatening complications. It also highlights the growing role of imaging, evolving extraction tools, and standardized protocols in improving outcomes. In addition, the document addresses system-level considerations, including training requirements, operator competency, and institutional infrastructure needed to support safe and effective extraction programs.

This expert consensus statement update reflects broad international collaboration, incorporating perspectives from multiple professional societies across cardiology, electrophysiology, infectious diseases, and cardiothoracic surgery. It is intended to support clinicians in delivering evidence-informed, patient-centered care in an increasingly complex procedural landscape.

Overall, the document serves as a key resource for clinicians involved in the management of patients with CIEDs, offering updated guidance to inform clinical decision-making, enhance procedural safety, and improve patient outcomes.