title: Predictors of advanced lead extraction based on a systematic stepwise approach: results from a high volume center.
abstract: BACKGROUND
  Lead extraction (LE) techniques have evolved from simple traction to extraction with dilators and powered sheaths with very high success rates. On the basis of the systematic implementation of a stepwise approach, we aimed to identify those characteristics that can predict the need for advanced LE techniques.
  
  
  METHODS
  Between April 2005 and March 2012, 208 consecutive LE procedures were performed and 456 leads were extracted using an initial superior approach. Advanced techniques for LE (step 4 according to our stepwise approach) were used in 122 patients (58.7%).
  
  
  RESULTS
  Younger patient age (odds ratio [OR] = 0.963, P = 0.002), longer duration of the initial implantation (OR = 1.013, P = 0.002), the number of extracted leads (OR = 2.184, P < 0.001), and the presence of right ventricular defibrillator leads (OR = 2.144, P = 0.049) independently predicted the necessity of using step 4 in multivariate analysis. A prediction tool was created taking into account four categorical variables derived even from Receiver Operating Curve analysis of quantitative characteristics (age < 70.7 years, implant duration > 37 months, extraction of at least two leads, one of them being a defibrillator lead). The absence of all the four characteristics was accompanied by 0% positive predictive value for the requirement of step 4 for LE, whereas the coexistence of all four risk factors is characterized by 87% requirement of advanced LE.
  
  
  CONCLUSIONS
  In most of the patients with indication for LE, use of a powered sheath extraction is necessary in order to obtain clinical success. We have identified four patient and lead characteristics that may help the operator plan the means of extraction.
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy. mazzone.patrizio@hsr.it
authors.forename: Patrizio
authors.initials: P
authors.lastname: Mazzone
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciconte
authors.forename: Gabriele
authors.initials: G
authors.lastname: Paglino
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Sora
authors.forename: Simone
authors.initials: S
authors.lastname: Sala
authors.forename: Pasquale
authors.initials: P
authors.lastname: Vergara
authors.forename: Simone
authors.initials: S
authors.lastname: Gulletta
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D020878:Device Removal / Q000295:instrumentation / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult
keywords: implanted cardioverter defibrillators; lead extraction; pacemakers