Clinical Experiences in Lead Extraction

Since the development of effective techniques for transvenous removal of permanent pacing leads, a large volume of experience regarding clinical results of these techniques has been published [1]. The development of different techniques, mainly differing due to the type of energy used for dilatation, raised the debate about their relative superiority. As always happens when clinical results have to be analyzed, evaluated, and compared with different experiences, it is difficult to assess the relative importance of the technique itself, operator skill and experience, and how those procedures and their results are applicable to physicians and clinical practice in their particular field of interest. This general observation is particularly important with regard to transvenous lead extraction. 

2nd Cardiovascular Department AOUP, Santa Chiara University Hospital, Pisa, Italy 

To evaluate results, another key point is to define complications. The HRS expert consensus document defined a major complication as any outcome related to the procedure that is life threatening or results in death. Major complications include the development of persistent or significant disability and conditions requiring significant surgical intervention to prevent unfavorable outcome [3]. 

The use of implantable cardiac devices significantly increased over recent years. However, pacing and implantable cardioverter-defibrillator (ICD) lead-related complications are not rare in 

Bongiorni (Ed.), Transvenous Lead Extraction. Springer-Verlag Italia 2011 

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Byrd CL et al (2002) Clinical study of the laser sheath for lead extraction the total experience in the United States. Pacing Clin Electrophysiol 25(5) 804-808... 

The concern about ICD extraction using conventional equipment was averted by clinical results. Even if extraction procedures were complex and time consuming, the final outcome showed no outstanding differences in comparison with results of PM lead extraction. Results of ICD lead extraction using mechanical sheaths were included in the US Lead Extraction Database published in 1999 [17], and early trials on laser-assisted sheaths were performed for both PM and ICD leads [21, 23, 45]. In 2000, Kantharia et al. reported their experience with transvenous extraction of 47 transvenous high-voltage leads implanted in 42 patients [46]. All leads were extracted - 11 by traction and 36 by mechanical dilatation - in the absence of serious complications. Extraction time was related to time from implant and degree of... 

All structures were selected from the Ensemble database. In addition to approved therapeutic agents these particularly include a set of lead compounds entered in advanced clinical/preclinical trials (a total of 16,540 compounds). Structures were extracted according to the assigned activity class, where the class indicates a common target-specific group such as GPCRs, kinases and proteases, nuclear receptors, and ion channels as well as more than 150 subclasses (for example, serotonin, tachykinin and dopamine receptors, tyrosine, Abl, Aurora and serine/threonine kinases, cysteine and serine proteases, etc.). Prior to the statistical experiments, the molecular structures should be filtered and normalized in order to fulfill certain criteria (see Subheading 3.5 and 4). 

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