Lead Extraction Certification Resources and Guidelines

Rules for Lead Extraction Certification

The LECC recommend that only practitioners who meet these certification and recertification criteria should perform percutaneous lead extraction procedures and it is the responsibility of the practitioners and hospitals to ensure this.

Review the criteria and process here

Lead Extraction Logbook Template

Please use this logbook template for your application submission. Note: Logbooks containing identifiable patient information will be immediately deleted.

Download template

Lead Extraction Certification

The Lead Extraction Certification Committee (LECC) is a Committee of the Cardiac Accreditation Services Limited (CASL) which addresses the issue of certification of practitioners for extraction of chronically implanted pacemaker leads and the registration of such practitioners with Medicare Services Australia.

Extraction of a chronically implanted lead is defined as removal of a pacemaker or defibrillator lead which:

  1. Has been implanted for more than 6 months, or
  2. Requires the use of specialised instruments for removal (including snares, sheaths and locking stylets), or
  3. Is removed via a route different from the route of implant.

Certification and Re-Certification Process

For certification, LECC accept applications throughout the year, with an aim to provide an initial decision within 6 weeks of submission. Re-certification is required annually, existing certified extractors will be notified of upcoming closing dates (typically March of each year).

Applications for certification are reviewed by the Certification Committee and the applicant advised accordingly. In the event that an applicant does not meet the necessary certification criteria, the Certification Committee shall provide advice upon what further training or documentation is required.

The LECC recommend that only practitioners who meet these certification and recertification criteria should perform percutaneous lead extraction procedures and it is the responsibility of the practitioners and hospitals to ensure this.

Suitably qualified practitioners who wish to apply for certification and listing on the Register should submit their completed application form together with a letter of application and supporting documentation (see below) to the LECC, via the Secretariat of CASL. Supporting documentation should include:

  1. Curriculum vitae, including details of specialist training in cardiology or cardiothoracic surgery and subsequent training in cardiac pacing.
  2. Documentation of experience as the primary operator in performance of extraction of chronically implanted pacing and defibrillator leads, including summary of outcomes and any adverse events (please note, logbook submissions will only be accepted if in alignment with the LECC logbook requirements).
  3. Independent certification of experience in lead extraction by a qualified operator for such lead extraction, who will usually be the training supervisor.
  1. For new operators: safe performance, as primary operator, of a minimum of 20 extractions of chronically implanted leads, under supervision of a currently certified operator (or a supervisor of equivalent experience and standing if training was completed overseas)
  2. In assessing an application for accreditation the LECC may consider, in addition to the number of leads extracted, other factors including (but not limited to):
    • The time taken to achieve the required lead numbers (usually a maximum of two years).
    • The dwell time of removed leads.
    • Extraction techniques and tools employed.
    • The mix of lead types (eg. Pacing leads v ICD leads, leads of known additional complexity etc.).
    • Indication for extraction.
    • Type and number of procedural complications.

Re-Certification

In order to maintain ongoing Medicare certification to perform Transvenous Lead Extraction, operators are required to submit a logbook of procedures annually.

In order to endure that transvenous lead extraction in Australia and New Zealand is performed at an internationally comparable minimum standard, to maintain accreditation practicers are required to perform a minimum of 15 procedures and 20 leads per calendar year.

These figures align with the requirements of both the European Heart Rhythm Association and the Heart Rhythm Society (US).

 

Please include the following information:

  • Primary operator for each case. If two or more accredited operator work together, where possible, the primary operator should be identified. Where there is a joint primary operator, this should be clearly stated.
  • Number and type of leads for each patient, the implant duration, and the indication for extraction. Data should be presented on a per lead/per patient basis. Summarised data are not considered sufficient.
  • For indications, use as a guide the categories Local infection, Endocarditis, Lead Problem including Recall Leads, Other.
  • State the procedural results as Complete Removal, Partial Removal, Failed Removal.
  • Document complications particularly the need for emergency pericardiocentesis or thoracic surgery, death during the procedure, in-hospital and at 30 days.

Failure to meet these numbers in a single year will not automatically result in de-certification, but will be looked at on an individual basis, taking into account (a) lifetime experience and (b) success and safety record (in line with British Heart Rhythm Society Criteria 2018) or (c) exceptional circumstances (for example, but not limited to, a period of maternity, sick or study leave that prevented the operator from completing the required number of procedures during that time).

If the Committee has concerns about ongoing certification, this will be expressed formally, and the operator will be given the opportunity to attempt to increase procedural numbers/safety. Committee members will provide support in this process as requested.

Appeals

Medical practitioners, whether certified for extraction of chronically implanted pacing and defibrillator leads or not, shall have a right of appeal against the decisions of the Certification Committee. Appeals shall be required to be lodged in writing with Chair of the Committee, no later than 3 months after the date of the decision by the Committee.

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