Australian Government - Department of Health and Ageing

Medical Services Advisory Committee (MSAC)

Application 1010

Intravascular extraction of chronically implanted permanent transvenous pacing leads

Application No.

1010
Application NameIntravascular extraction of chronically implanted permanent transvenous pacing leads
Advisory PanelsDr Richard King
(Chair and MSAC member)
Dr Ross Blair
(MSAC member)
Dr Michael Davis
(Cardiac Society of Australia and New Zealand nominee)
Date Received by MSAC Secretariat3 May 1999
Stage 1 - EligibilityEligible
Stage 2 - AssessmentCompleted
Stage 3 - Formulation of Advice to the MinisterThis assessment was considered by the MSAC at the 19 May 1999 meeting.

The MSAC noted that the procedure is being performed by a small number of cardiologists and that it can be claimed under the MBS. However, additional remuneration has been sought. The MSAC also noted that the available evidence indicates that extraction of chronically implanted permanent transvenous pacemaker leads using surgical tools and countertraction is an effective procedure which offers a minimally invasive and generally safe alternative to open heart surgery when performed by skilled operators with specialised training and experience. It is a much longer, more difficult and skilled procedure than extraction of leads not entrapped by fibrous tissue, which is performed by simple traction without the use of surgical tools. Currently both procedures are remunerated at the same rate. The MSAC therefore recommended that, on the strength of the evidence pertaining to the extraction of chronically implanted transvenous pacemaker leads:
  • additional public funding would be supported for the extraction of chronically implanted permanent transvenous pacemaker leads which have been implanted more than three months and require use of surgical tools and counteraction for their removal; and
  • the performance of the procedure should be restricted to cardiologists and cardiothoracic surgeons who have undergone specialist training in the procedure and are willing to participate in an audit program administered by the Cardiac Society of Australia and New Zealand, in order to achieve accreditation as a specialist provider of the procedure.
Stage 4 - DecisionEndorsed by the Minister for Health and Ageing 8 September 1999
Stage 5 - ImplementationImplemented