Complications of a Stepwise Approach for Transvenous Lead Extraction
Complications of a Stepwise Approach for Transvenous Lead Extraction
It is an observational study of predictors of complications and difficulty of trans-venous
 lead extraction procedure. This procedure is done for patient who had a previous cardiac
 pacemaker or defibrillator implantation which had a dysfunction or infection so needed to be
 extracted.
The number of cardiac implantable electronic device (CIED) implantations has increased over
 recent years (1) with approximately 1.2-1.4 million CIEDs are being implanted annually
 worldwide.(2) Consequently this has been associated with increasing rates of infection and
 lead malfunctions, affecting approximately 1-2% of all CIED cases.(3)

 Recently, it is estimated that between 10 000 and 15 000 leads are extracted worldwide each
 year.(4) Over the past few decades, transvenous lead extraction (TLE) has evolved as the
 preferred method for leads removal being less invasive compared to surgical removal by open
 heart surgery which is now reserved for cases with high risk procedures or a very large
 vegetation.

 Most frequent indications for TLE are infection (accounting for 52.8%) and lead dysfunction
 (accounting for 38.1%) of all cases of TLE. (5)

 There have been different approaches (superior and inferior approaches) and techniques for
 TLE. Current techniques employ mechanical and/or laser equipment with variable success rates.
 The locking stylet has been the principal tool in these techniques, while the telescoping
 (powered or non-powered) mechanical or laser sheaths serve as the most important ancillary
 tools.

 Despite being a safe procedure with minor complications ranging from 0.06 to 6.2%, but
 serious complications may still arise in 0.2-1.8 % of cases in even the most experienced
 hands with mortality rates in several large registries amounting 0.2 - 1.2 %.(6) Although
 many studies have tried to identify risk factors for complications including patient/lead
 profile and centre/operator experience, major studies still have conflicting results.

 Recently, the hybrid approach, with mini-thoracotomy or thoracoscopy, has been introduced and
 supposed to be associated with increased safety in challenging TLE procedures. (7, 8)
Inclusion Criteria:

 -  All consecutive patients referred for lead extraction with class I and IIa indications
 according to 2017 HRS expert consensus statement on CIED lead management and
 extraction.

 Exclusion Criteria:

 -  Patients primarily requiring surgical extraction