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Late complications of electrotherapy - a clinical analysis of indications for transvenous removal of endocardial leads: a single centre experience.

BACKGROUND
Despite advances in electrotherapy, late complications constitute an increasing clinical and therapeutic problem. Transvenous lead extraction (TLE) is becoming a safe and effective approach to the treatment of such complications.


AIM
To assess indications for TLE and to evaluate safety and efficacy of TLE procedures.


METHODS
A retrospective clinical analysis of 100 patients with complications of electrotherapy admitted to a tertiary care centre in 2008-2011.


RESULTS
In 2008-2011, the number of electrotherapy complications increased markedly. The most frequent reason for TLE was lead dysfunction (62% of patients, including 31% with an implanted cardioverter-defibrillator [ICD] and 31% with a pacemaker [PM]). The most common type of lead dysfunction was conductor damage (38% of patients, including 23% with ICD, 15% with PM), followed by late myocardial perforation (14% of patients, including 7% with ICD, 7% with PM), abnormal course of the lead (7% of patients, including 1% with ICD, 6% with PM), and lead insulation failure (3% of patients). Other reasons for TLE were infectious complications (24% of patients, including 15% with PM pocket infection), venous insufficiency (17% of patients, including 10% in whom an indwelling lead was a direct obstacle to switching the pacing mode), and the need to switch the pacing mode (4% of patients). Procedural efficacy was 96% (lead fragments were left in place in 4% of patients). No significant clinical complications were observed in any of the patients in the periprocedural period.


CONCLUSIONS
Clinical manifestations of electrotherapy complications in the study group varied and included a relatively small number of infectious complications (24%) and a relatively large number of late myocardial perforations (14%). Efficacy and safety of the procedures were very high.