Introduction
Transvenous lead extraction (TLE) is considered first-line strategy for
the management of complications associated with cardiac implantable
electronic devices (CIED) [1,2]. Recently, due to the rising
incidence of infectious and non-infectious CIED-related complications,
the number of TLE has also been increasing [3]. According to
numerous reports, the frequency of major complications of TLE ranges
from 0.9 to 4.0%, and most often there is damage to the heart or venous
vessels [4-7]. Assessment of risk factors for major complications
and procedure complexity should have an impact on the selection of a
suitable organizational model of the procedure and center preferment
[4-7]. The available TLE risk stratification scales most often take
into account the impact of various factors on the technical complexity
of the procedure [4-7] or periprocedural mortality [4-7]. They
are based on demographic and clinical data (patient age, gender,
presence of co-morbidities ), type of CIED system (ICD lead, number of
leads) and history of pacing (age at first implantation, number of leads
designed for extraction) [4-7]. This is the first study to assess
the usefulness of new factors that may significantly affect the level of
difficulty and procedure complexity as well as efficacy and
complications of TLE. These factors were identified during an
echocardiographic examination of patients selected for TLE due to
CIED-related complications. Echocardiography, especially transesophageal
echocardiography plays a key role in the evaluation of rhythm
controlling devices (PM/ICD/CRT) and remains a valuable tool for precise
imaging, which is recommended by experts [8-15]. Although a number
of studies focused on the value of preoperative TEE findings (size of
vegetations, presence of asymptomatic masses on the leads), the only
echocardiographic parameter discussed when estimating the
procedure-related risk was left ventricular ejection fraction (LVEF),
only few studies so far have suggested that TEE can be used apart from
fluoroscopy or computerized tomography [7] to choose optimal TLE
strategy [16,17], nevertheless the effect of echocardiographic
findings on procedure safety and efficacy has not been assessed.