{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T08:46:17Z","timestamp":1794473177984,"version":"4.9.1"},"reference-count":18,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Infection, lead dysfunction and system upgrades are all reasons that transvenous lead extraction is being performed more frequently. Many centres focus on a single method for lead extraction, which can lead to either lower success rates or higher rates of major complications. We report our experience with a systematic approach from a less invasive to a more invasive strategy without the use of laser sheaths. Methods: Consecutive extraction procedures performed over a period of seven years in our electrophysiology laboratory were included. We performed a stepwise approach with careful traction, lead locking stylets (LLD), mechanical non-powered dilator sheaths, mechanical powered sheaths and, if needed, femoral snares. Results: In 463 patients (age 69.9 \u00b1 12.3, 31.3% female) a total of 780 leads (244 ICD leads) with a mean lead dwelling time of 5.4 \u00b1 4.9 years were identified for extraction. Success rates for simple traction, LLD, mechanical non-powered sheaths and mechanical powered sheaths were 31.5%, 42.7%, 84.1% and 92.6%, respectively. A snare was used for 40 cases (as the primary approach for 38 as the lead structure was not intact and stepwise approach was not feasible) and was successful for 36 leads (90.0% success rate). Total success rate was 93.1%, clinical success rate was 94.1%. Rate for procedural failure was 1.1%. Success for less invasive steps and overall success for extraction was associated with shorter lead dwelling time (p &lt; 0.001). Major procedure associated complications occurred in two patients (0.4%), including one death (0.2%). A total of 36 minor procedure-associated complications occurred in 30 patients (6.5%). Pocket hematoma correlated significantly with uninterrupted dual antiplatelet therapy (p = 0.001). Pericardial effusion without need for intervention was associated with long lead dwelling time (p = 0.01) and uninterrupted acetylsalicylic acid (p &lt; 0.05). Conclusion: A stepwise approach with a progressive invasive strategy is effective and safe for transvenous lead extraction.<\/jats:p>","DOI":"10.3390\/jcm12247613","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T14:12:51Z","timestamp":1702303971000},"page":"7613","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Stepwise Approach for Transvenous Lead Extraction in a Large Single Centre Cohort"],"prefix":"10.3390","volume":"12","author":[{"given":"Axel","family":"Kloppe","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany"},{"name":"Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assem","family":"Aweimer","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Sch\u00f6ne","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"El-Battrawy","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"},{"name":"Department of Molecular and Experimental Cardiology, Institut f\u00fcr Forschung und Lehre (IFL), Ruhr-University Bochum, 44801 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Hanefeld","sequence":"additional","affiliation":[{"name":"Department of Cardiology at Katholische Kliniken Bochum, Ruhr University Bochum, 44791 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9548-6995","authenticated-orcid":false,"given":"Andreas","family":"M\u00fcgge","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"},{"name":"Department of Molecular and Experimental Cardiology, Institut f\u00fcr Forschung und Lehre (IFL), Ruhr-University Bochum, 44801 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9776-8117","authenticated-orcid":false,"given":"Fabian","family":"Schiedat","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany"},{"name":"Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2995","DOI":"10.1093\/eurheartj\/ehx080","article-title":"The European Lead Extraction ConTRolled (ELECTRa) study: A European Heart Rhythm Association (EHRA) Registry of Transvenous Lead Extraction Outcomes","volume":"38","author":"Bongiorni","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"402","DOI":"10.5603\/CJ.2013.0099","article-title":"Lead dependent tricuspid dysfunction: Analysis of the mechanism and management in patients referred for transvenous lead extraction","volume":"20","author":"Polewczyk","year":"2013","journal-title":"Cardiol. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1093\/europace\/euy050","article-title":"2018 EHRA expert consensus statement on lead extraction: Recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: Endorsed by APHRS\/HRS\/LAHRS","volume":"20","author":"Bongiorni","year":"2018","journal-title":"Europace"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e503","DOI":"10.1016\/j.hrthm.2017.09.001","article-title":"2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction","volume":"14","author":"Kusumoto","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2702","DOI":"10.19102\/icrm.2017.080502","article-title":"Strategies for Transvenous Lead Extraction Procedures","volume":"8","author":"Epstein","year":"2017","journal-title":"J. Innov. Card. Rhythm. Manag."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/europace\/euu378","article-title":"How adequate are the current methods of lead extraction? A review of the efficiency and safety of transvenous lead extraction methods","volume":"17","author":"Buiten","year":"2015","journal-title":"Europace"},{"key":"ref_8","unstructured":"Doyle, D.J., Hendrix, J.M., and Garmon, E.H. (2022). American Society of Anesthesiologists Classification, StatPearls Publishing."},{"key":"ref_9","first-page":"1710","article-title":"Outcomes and costs associated with two different lead-extraction approaches: A single-centre study","volume":"19","author":"Gaubert","year":"2017","journal-title":"Europace"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1093\/europace\/eut086","article-title":"Transvenous lead extractions: Comparison of laser vs. mechanical approach","volume":"15","author":"Starck","year":"2013","journal-title":"Europace"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1111\/j.1540-8159.2012.03400.x","article-title":"Percutaneous extraction of cardiac implantable electronic devices (CIEDs) in octogenarians","volume":"35","author":"Williams","year":"2012","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1540-8159.2011.03273.x","article-title":"Large, single-center experience in transvenous coronary sinus lead extraction: Procedural outcomes and predictors for mechanical dilatation","volume":"35","author":"Bongiorni","year":"2012","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1111\/j.1540-8167.2012.02392.x","article-title":"Cardiac venous left ventricular lead removal and reimplantation following device infection: A large single-center experience","volume":"23","author":"Rickard","year":"2012","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1080\/AC.67.6.2184666","article-title":"Transvenous extraction of pacing and defibrillator leads\u2014A single-centre experience","volume":"67","author":"Geselle","year":"2012","journal-title":"Acta Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1093\/europace\/eux218","article-title":"Effectiveness, safety, and long-term outcomes of non-powered mechanical sheaths for transvenous lead extraction","volume":"20","author":"Kutarski","year":"2018","journal-title":"Europace"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/europace\/euac200","article-title":"A head-to-head comparison of laser vs. powered mechanical sheaths as first choice and second line extraction tools","volume":"25","author":"Zsigmond","year":"2023","journal-title":"Europace"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1093\/europace\/euaa027","article-title":"The MB score: A new risk stratification index to predict the need for advanced tools in lead extraction procedures","volume":"22","author":"Bontempi","year":"2020","journal-title":"Europace"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"629","DOI":"10.2147\/VHRM.S369342","article-title":"Severity and Extent of Lead-Related Venous Obstruction in More Than 3000 Patients Undergoing Transvenous Lead Extraction","volume":"18","author":"Czajkowski","year":"2022","journal-title":"Vasc. Health Risk Manag."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/24\/7613\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:36:35Z","timestamp":1760132195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/24\/7613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,11]]},"references-count":18,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["jcm12247613"],"URL":"https:\/\/doi.org\/10.3390\/jcm12247613","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,11]]}}}