What’s New With the Guidelines? Interview With Charles Love, MD
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EP LAB DIGEST. 2026;26(4).
Interview by Jodie Elrod
In this feature interview, EP Lab Digest talks with Dr. Charles Love about his presentation at ACC 2026 presentation, “Leading the Way: What’s New With the Guidelines?”
Your ACC 2026 session focuses on what’s new in the latest guidelines. What key themes or areas of evolution did you highlight for clinicians?
Early intervention for infected systems, including device removal and lead extraction, is a key focus, as performing these procedures within 7 days of diagnosis has been shown to significantly reduce morbidity and mortality—the earlier, the better.
Another important evolution is the growing use of percutaneous aspiration of vegetations as an alternative to open-heart surgical removal.
There is also an increased emphasis on thoughtful decision-making at the time of device implantation, including avoiding dual-coil implantable cardioverter-defibrillator leads, considering non-transvenous systems when appropriate, and minimizing the number of leads in the vasculature and across the tricuspid valve.
Finally, proper use of a venous occlusion balloon during lead extraction procedures—particularly in the event of a superior vena cava tear—can dramatically improve survival, increasing it from approximately 50% to as high as 90%.
From a practical standpoint, what are a few actionable steps lead extraction programs can take today to align with the direction these updated guidelines are heading?
Lead extraction programs can begin by creating streamlined processes to facilitate the timely extraction of patients with infected or malfunctioning devices.
They should also develop collaborative programs that bring together cardiac surgery and infectious disease experts to effectively manage patients with infected cardiac implantable electronic device systems.
In addition, adopting a “Heart Team” approach can help ensure optimal care for patients who are candidates for tricuspid valve interventions.
Programs can further benefit from working closely with hospital administrators to recognize that lead management can be financially advantageous for the medical center, as hospitals receive reimbursement through diagnosis-related groups for the surgical support required during lead extraction procedures.
Finally, it is important to recognize that lead extraction is a safe procedure when performed by experienced operators in the appropriate setting, with mortality rates typically below 0.5%—significantly lower than the risks associated with untreated or undertreated infections.
As techniques and technologies continue to evolve, where do you see the biggest opportunities—or challenges—for the future of lead extraction and lead management?
One of the biggest challenges is managing the older leads that are now being referred for extraction. In this context, there may be a potential use of technologies such as the Shockwave lithotripsy balloon (Shockwave Medical) to pre-treat calcified binding sites.
There is also a growing opportunity for innovation in the development of new tools designed specifically for femoral extraction approaches.
Another important area is the management of patients undergoing percutaneous tricuspid valve repair or replacement, where careful planning is needed to avoid lead entrapment, which can increase the risk of future extraction difficulties and lead failure.
Finally, the field will likely benefit from the development of higher-volume centers to ensure quality outcomes, supported by cooperative arrangements between hospitals and surgical teams to streamline and expedite procedures.
