title: The current practice and perception of cardiac implantable electronic device transvenous lead extraction in the UK.
abstract: OBJECTIVE
  The number of patients requiring an extraction of cardiac implantable electronic devices (CIEDs) is rising. Lead extraction of chronically implanted leads is a highly specialized procedure and the Heart Rhythm Society published a consensus document outlining best practice. We sought to ascertain the current practice and perception of lead extraction in the UK.
  
  
  RESULTS
  A prospective e-mail survey consisting of 21 questions was sent to members of Heart Rhythm UK. Key areas for exploration included case volume, settings for extraction procedures, levels of surgical support, preferred techniques, and the perceptions of difficulty, risk, morbidity, and mortality associated with lead extraction. Thirty responses were received giving a response rate of 9.3%. Eighty-three per cent of responders performed extractions regularly and of these 92% were electrophysiologists. Median number of cases performed per year was 13 (interquartile range 6-26). Fifty-six per cent performed <20 procedures per year. Eighty per cent of procedures were performed in the electrophysiology (EP) laboratory and of these 50% had no identifiable surgeon or operating theatre on standby. Mechanical dissection sheaths were the most widely used method of extraction after failure of manual traction (63%). The risk of minor complications was perceived to be 4% or less by the majority of respondents across the device range. The same measure for major complications and death was 2 and 1%, respectively.
  
  
  CONCLUSIONS
  Increased operator caseload and closer links between EP extractors and surgeons should be seen as achievable goals.
authors.affiliation: Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK. manav.sohal@gstt.nhs.uk
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.forename: Steven E
authors.initials: SE
authors.lastname: Williams
authors.forename: Aruna
authors.initials: A
authors.lastname: Arujuna
authors.forename: Zhong
authors.initials: Z
authors.lastname: Chen
authors.forename: Julian
authors.initials: J
authors.lastname: Bostock
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Gill
authors.forename: Christopher Aldo
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D020878:Device Removal / Q000401:mortality*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data