[Percutaneous lead extraction. Complications and their management]

Area of Science:

• Cardiology
• Medical Interventions

Background:

• Percutaneous lead extraction for cardiac implantable electronic devices (CIEDs) is a complex procedure.
• Despite advancements, life-threatening complications remain a concern, as indicated by the ELECTRa registry.
• Thorough pre-operative assessment is essential for managing individual operation risks.

Purpose of the Study:

• To highlight the critical importance of pre-operative screening and risk assessment in percutaneous lead extraction.
• To emphasize the need for preparedness and structured management strategies to mitigate complications.

Main Methods:

• Review of data from the ELECTRa registry regarding lead extraction outcomes and complications.
• Analysis of pre-operative factors influencing procedural risk.
• Emphasis on intraoperative decision-making and emergency management protocols.

Main Results:

• Pre-operative screening (indications, infection, dependency, lead type, prior surgery, anatomy) is vital for risk assessment.
• Risk-adjusted settings and intraoperative escalation of methods are necessary.
• Intraoperative transesophageal echocardiography (TEE) aids in early complication detection.
• Team approach and preoperative arrangements enhance emergency management.

Conclusions:

• Careful patient selection and risk stratification are paramount for safe lead extraction.
• A multidisciplinary team approach and preparedness for complications are key to reducing mortality.