Heart Rhythm 2026: Blueprint Established for Cardiovascular Electronic Device Lead Management

The Heart Rhythm Society revealed recommendations aimed at guiding clinicians and patients in choosing the right cardiovascular implantable electronic device (CIED) and managing it over time to reduce complications and support a better quality of life.

At Heart Rhythm 20206 in Chicago, the Society shared the new “2026 HRS/AHA/APHRS/EHRA/IDSA/LAHRS/PACES/STS Expert Consensus Statement Update on Cardiovascular Implantable Electronic Device Lead Management and Extraction,” which appeared in Heart Rhythm, the official journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society, and the Pediatric & Congenital Electrophysiology Society, published by Elsevier.

Over the past 70 years, CIEDs have become an established treatment option for certain patients with bradycardia, tachycardia, and heart failure. It is estimated that in 2022, 800,000 CIEDs were implanted in the United States. Future CIED implant rates are expected to be higher due to the global aging population, particularly for permanent pacemakers.

CIEDs traditionally use leads that connect the pulse generator to cardiac tissue. Since publication of the “2017 HRS Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction,” the field has evolved quickly with the publication of new evidence on CIED transvenous lead management, development of new CIED technologies that are leadless or use leads implanted outside the vascular system, wide adoption of leads that do not have a lumen, new lead extraction tools, and new cardiac and vascular procedures that have lead management implications.

“A holistic approach to CIED selection and use is required, as is, by extension, consideration of potential lead management implications over a patient’s lifetime,” noted Yong-Mei Cha, M.D., Mayo Clinic (Rochester) and Writing Committee chair. “The document we present is intended to help clinicians in their decision-making process for managing leads and CIED implant considerations and updates the 2017 expert consensus statement.”

The consensus statement’s writing committee consisted of internationally recognized experts from five countries in clinical electrophysiology, pediatric electrophysiology, cardiothoracic anesthesiology, cardiothoracic surgery, and infectious diseases, representing multiple professional societies. They systematically reviewed scientific evidence and translated their findings into recommendations to improve CIED lead management care quality. This current expert consensus statement focuses on providing an update on practical clinical guidance in the broad field of lead management, including extraction and management of traditional CIEDs that use transvenous leads, CIEDs with extravascular or subcutaneous leads, and leadless CIEDs.

The new recommendations address the latest CIED technologies with advantages over transvenous leads, new evidence supporting diagnosis, treatment, and prevention for CIED infection, appropriate lead management in transcatheter tricuspid valve replacement for tricuspid regurgitation, and standardization of transvenous lead extraction approach, protocol, and facilities to improve CIED lead management and extraction outcomes.

“Newer technologies in CIED offer the potential to decrease the clinical challenges and morbidity associated with intravascular devices. Since the 2017 consensus statement, the use of leadless pacing and non-vascular implantable cardioverter defibrillators has increased substantially, ushering in a new paradigm of non-vascular cardiac rhythm management,” Dr. Cha said. “Future lead management considerations must be taken into account when any CIED—including leadless pacemakers—is implanted. At initial CIED implant or subsequently when a generator or lead needs to be replaced or revised, device choice and lead management issues include clinical indication, patient comorbidities, predicted patient lifespan, lead performance, consequences of any future CIED complication, and potential clinical benefit and risks. This collaborative approach ensures that device and lead selection and management strategies align with the patient’s long-term health, personal preferences, and quality of life to optimize outcomes over time.”

The Heart Rhythm Society (HRS) has developed expert consensus documents that have guided clinical care in managing cardiac arrhythmias since 1996. This HRS-led expert consensus statement was jointly developed by the American College of Cardiology (ACC), the American Heart Association (AHA), the American Society of Anesthesiologists (ASA), the Asia Pacific Heart Rhythm Society (APHRS), the European Heart Rhythm Association (EHRA), the Infectious Diseases Society of America (IDSA), the Latin American Heart Rhythm Society (LAHRS), the Pediatric and Congenital Electrophysiology Society (PACES), and the Society of Thoracic Surgeons (STS).

The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients and is the primary information resource on heart rhythm disorders. Its mission is to improve patient care by promoting research, education, and optimal healthcare policies and standards. Incorporated in 1979 and based in Washington, D.C., its membership consists of more than 9,000 heart rhythm professionals from 94 countries.

The Heart Rhythm Society’s annual Heart Rhythm meeting convenes 10,000 of the world’s clinicians, scientists, researchers, and innovators in cardiac pacing and electrophysiology. More than 2,000 international experts in the field serve as faculty for the 200-plus educational sessions, forums, symposia, and ceremonies, while over 110 exhibitors showcase their products and services.