Lead Extraction – Future Treatment for an Old Problem

The implantation rate of electronic cardiac devices, such as pacemakers and implantable cardiac defibrillators, has grown substancially over recent years. As a consequence, we are facing a rising number of related complications, such as systemic and/or local infections and malfunctions. It is generally accepted that transvenous lead extraction (TLE) is actually the better strategy to manage the majority of such complications, although the procedure is not exempt from minor and major risks. Despite the advent of laser techniques, surgery may still be required in both elective and emergency cases. Hybrid operative strategies (TLE combined with minithoracotomy and thoracoscopy) have been developed for procedures considered to confer an high risk. The strict collaboration between electrophysiologist and cardiac surgeon, and the setting up of a multidisciplinary team, are crucial points at each step of a planned TLE procedure.