title: Late complications of electrotherapy - a clinical analysis of indications for transvenous removal of endocardial leads: a single centre experience.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Second Clinical Department of Cardiology, Regional District Hospital, Kielce, Poland. annapolewczyk@wp.pl
authors.forename: Anna
authors.initials: A
authors.lastname: Polewczyk
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kutarski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tomaszewski
authors.forename: Maciej
authors.initials: M
authors.lastname: Polewczyk
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005260:Female; D006335:Heart Injuries / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000209:etiology* / Q000517:prevention & control