経皮的リードレスペースメーカー抜去：時期、対象、場所、方法

The widespread adoption of leadless pacemakers has introduced new clinical and technical challenges related to device management at end of service and in the setting of device-related complications. While transvenous lead extraction is an established treatment strategy for conventional pacing systems, there is currently no standardized framework for transvenous leadless pacemaker extraction (TLLE). With increasing numbers of leadless pacemakers approaching end of service and expanding indications for leadless pacing, a structured approach to TLLE has become clinically relevant. This review proposes a systematic concept of TLLE, including definitions, clinical indications, procedural strategies, risk assessment, and institutional requirements. Indications for TLLE including device end-of-life, dislocation, interactions, infection, or the need for upgrade to a different device were summarized. Procedural strategies, primarily based on the extraction most frequently from the femoral approach, with the use of snare-based techniques, with the choice of other tools and access tailored to device type, dwell time, fixation mechanism, and degree of encapsulation, have been summarized. Literature findings reporting high success rates were presented, with potential complications, such as cardiac perforation, tamponade, tricuspid valve injury, embolization, and vascular access complications, being summarized as well. Patient selection, pre-procedural imaging have also been evaluated, and factors influencing decision-making, including balance of periprocedural risk against long-term implications of device abandonment have been presented.