(Hellenic Journal of Cardiology) HJC • 55 Hellenic J Cardiol 2015; 56: 55-60 Manuscript received: January 19, 2014; Accepted: June 27, 2014. Address: Skevos Sideris State Cardiology Division Hippokration Hospital 114 Vasilissis Sofias St. 115 28 Athens, Greece skevos1@otenet.gr Key words: Cardiac electronic devices, infection, mechanical extraction. Original Research Original Research Transvenous Extraction of Cardiac Rhythm Device Leads: A Report of the Experience from a Single Referral Centre in Greece SkevoS SideriS 1 , AlexAndroS kASiAkogiAS 1 , MAriA PirounAki 2 , koStAS gAtzouliS 3 , iliAS SotiroPouloS 1 , PolichroniS dilAveriS 3 , koStAS trAxAnAS 1 , APoStoloS voliotiS 1 , koStAS MAnAkoS 1 , diMitriS konStAntinidiS 1 , george trAntAliS 1 , diMitrioS lyMPeriAdiS 4 , george StAvroPouloS 4 , diMitrioS touSouliS 3 , ioAnniS kAllikAzAroS 1 1 State Cardiology Division, 2 Department of Internal Medicine, 3 First Cardiology Clinic, University of Athens, 4 Department of Cardiac Surgery, Hippokration Hospital, Athens, Greece Introduction: As rates of implanted cardiac electronic devices continue to rise, lead extraction procedures are crucial for the management of complications. The optimal method for such procedures has been con- stantly debated. We sought to review our experience of lead extraction using a conventional technique. Methods: This was a retrospective study of lead extraction procedures in a major referral centre in Greece. Leads were extracted in a series of 66 consecutive patients (69% men, age range 53-90 years) who visited our centre between August 2008 and June 2012. The extraction procedure was performed in the catheteriza- tion lab with a widely used system composed of a locking stylet and sheath. Results: A total of 120 leads were extracted (51 atrial, 69 ventricular) including 19 defibrillator leads and 9 coronary sinus leads. The most frequent indication for lead extraction was infective endocarditis (28 pa- tients, 42%), followed by generator pocket infection (22 patients, 33%), and lead malfunction (16 patients, 24%). Extraction was achieved through the venous entry-site approach in all procedures. The leads were completely extracted in 65 patients (98.5%). Only one complication was recorded: perforation of the right atrium in one patient (1.5%), who eventually underwent emergency cardiac surgery with a good outcome. Conclusions: Our data confirm that a conventional mechanical technique is highly effective for successful extraction of all types of implanted cardiac electronic device leads and is associated with very limited com- plications. A s the numbers of cardiac implant- able electronic devices (CIED) continue to rise worldwide, lead extraction has become a critical procedure in managing device-related complications. Lead removal is the main treatment ap- proach in cases of lead failure or infection, as well as in order to upgrade to new tech- nology. 1,2 During the past two decades, the field of CIED lead extraction has ex- panded from the use of rudimentary kits delivering simple traction, to the use of complex telescoping sheaths, excimer la- ser, or radiofrequency energy designed to disrupt adhesions. 3,4 Despite these con- tinuous advances in lead extraction tech- nology, such procedures continue to be as- sociated with considerable morbidity and mortality, while the more recently intro- duced techniques are available in only a few centres. Furthermore, the benefits of powered sheaths over conventional me- chanical extraction tools with respect to success rates and cost-effectiveness have been questioned. 5,6 Several studies from high-volume