From Consensus to Clinical Practice: An APP's Perspective on Modern Lead Management and Extraction

Interview With Kelly M. Bergen, MSN, AGACNP-BC, FHRS, CCDS

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EP LAB DIGEST. 2026;26(9):12-13.

Interview by Jodie Elrod

As cardiovascular implantable electronic device (CIED) technology continues to evolve, so too does the complexity of lead management and extraction. The 2026 HRS Expert Consensus Statement underscores the importance of multidisciplinary care, shared decision-making, and standardized extraction protocols to improve patient outcomes. For advanced practice providers (APPs), these recommendations reflect an expanding role that extends far beyond procedural coordination. In this interview, Kelly M. Bergen, MSN, AGACNP-BC, FHRS, CCDS, discusses how APPs serve as critical connectors across the extraction team—helping patients navigate complex treatment decisions, managing the growing demands of remote monitoring and emerging technologies, and ensuring timely recognition and escalation of lead-related issues.

Can you start with a brief introduction about yourself?
I am the electrophysiology lead nurse practitioner and Arrhythmia Services Program Coordinator at CaroMont Health, located just outside Charlotte, North Carolina. My clinical role is comprehensive, spanning inpatient and outpatient arrhythmia management, first assist in EP lab, and serving as the clinical director of our growing CIED clinic. I am passionate about advancing care for patients with heart rhythm disorders through innovation, technology, and commitment to quality. 

The updated consensus statement emphasizes a multidisciplinary approach. From the APP perspective, what does successful coordination actually look like in day-to-day extraction care?
Successful coordination of a lead extraction procedure requires every member of the multidisciplinary team to work together to achieve a safe and successful outcome for the patient. This demands commitment from all members of the team, excellent communication, and meticulous attention to detail. Timing is critical when coordinating all the moving parts of an extraction procedure. In my experience, it truly takes a village to ensure success. 

Each team member plays an essential role, and the best outcomes depend on everyone understanding their responsibilities, maintaining clear communication, and collaborating effectively. Scheduled multidisciplinary “extraction team” meetings to review cases and develop a plan in advance are invaluable. Equally important is having a dedicated coordinator who oversees the details and scheduling required to ensure the procedure comes together seamlessly. In my current role, I perform several functions. I conduct the patient’s pre-procedural clinic visit, facilitate evaluation and shared decision-making, coordinate the necessary preprocedural testing and preparation, and ensure that all required elements are in place to support a safe, efficient, and successful procedure. On procedure day, I perform the H&P and troubleshoot any issues that may arise.

How has the growth of leadless pacing, nonvascular ICDs, and remote monitoring changed the workflow demands placed on APPs in electrophysiology programs?
The one constant in electrophysiology is the continuous evolution of technology. It is one of the things I love most about this field, but it is also one of its greatest challenges. As technology advances, devices become smaller, procedures become more efficient, and the volume of remote device transmissions continues to grow. 

APPs play a critical role in expanding access to care and helping meet the needs of this growing patient population. A thorough understanding of emerging technologies—including their risks, benefits, and long-term implications—is essential and includes consideration of whether a device may ultimately require extraction during its lifespan. Although leadless pacing and nonvascular implantable cardioverter-defibrillators may reduce some of the possible complications associated with traditional transvenous systems, they do not eliminate the need for ongoing monitoring and expert clinical oversight. 

Remote monitoring has perhaps had the greatest impact on daily workflow. The sheer volume of transmitted data and device-generated alerts continues to increase, requiring efficient systems for review, triage, and follow-up. APPs are frequently responsible for interpreting device data, coordinating additional testing when needed, communicating results to patients, and facilitating timely intervention when indicated. 

Shared decision-making is now central to lead management discussions. When patients are weighing extraction versus lead abandonment, what concerns tend to resonate most—including future MRI access, infection risk, vascular access preservation, and the long-term burden of retaining hardware? 
The risk-benefit profile of lead extraction is always foremost in my mind when evaluating a patient. Not all extraction indications carry the same weight in the decision-making process, and every patient presents unique considerations based on their clinical status, comorbidities, and individual goals of care. Determining the appropriate course of action requires careful assessment of both the immediate procedural risks and the long-term implications of retaining hardware.

For many patients, the long-term burden of abandoned or retained leads, including the associated risk of future infection, is not readily apparent. As a result, a thorough discussion outlining all relevant considerations is a critical component of the shared decision-making process. Patients must understand not only the risks of extraction, but also the potential consequences of leaving hardware in place.

From the patient perspective, I find that MRI compatibility has become an increasingly important consideration. As MRI utilization continues to grow across many areas of medicine, patients are often concerned about how their device and lead system may affect future access to advanced imaging. Incorporating these concerns into the discussion helps ensure that treatment decisions align with both current clinical needs and anticipated future healthcare requirements. 

APPs are often the first clinicians helping patients understand lead alerts, lead failure, and management options. How has your educational role evolved in recognizing potential lead problems, counseling patients, and ensuring timely escalation to an extraction team when needed?
APPs are on the front line of CIED care and are often the most accessible point of contact for patients as our healthcare system continues to manage increasing patient volumes. APPs are often the first clinicians to identify hardware-related issues via remote monitoring, in-office or hospital-based device evaluations, or patient-reported symptoms. This requires a strong understanding of device function, lead performance characteristics, and the ability to recognize subtle indicators that may signal developing lead failure. Combined with an understanding of the patient’s overall clinical picture, this expertise allows APPs to perform appropriate evaluations and promote early collaboration with extraction specialists, helping to ensure timely intervention before an urgent situation arises.

Equally important is helping patients understand what these findings mean. Lead alerts and abnormal device findings can create significant anxiety for patients, and they look to us to help translate the complex technical information into language they can understand. I strive to provide clear, comprehensive education about the nature of the problem, available treatment options, and the associated risks and benefits, as well as any additional testing that may be required. These conversations are essential to helping patients feel informed and engaged in the decision-making process.

APPs serve as a critical bridge to timely and effective care by identifying device and lead issues early, providing comprehensive counseling, facilitating informed decision-making, and coordinating timely referrals to extraction specialists.