title: Safety of transvenous lead extraction according to centre volume: a systematic review and meta-analysis.
abstract: BACKGROUND
  Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes.
  
  
  OBJECTIVE
  Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centres with low, medium, and high volume of procedures.
  
  
  METHODS
  Of the 280 papers initially retrieved until February 2013, 66 observational studies met inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; and 2 were defined 'experience studies'. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium, and high volume centres utilizing either the European Heart Rhythm Association (EHRA) or Lexicon classification criteria.
  
  
  RESULTS
  When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intraoperative deaths. In contrast, both minor complications and mortality at 30 days decreased as centre volume increased.
  
  
  CONCLUSIONS
  In our meta-analysis of observational studies, patients who have been treated in higher volume centres have a lower probability of minor complications and death at 30 days regardless of the infection rate, length of lead duration, type of device, and type of extraction.
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Antonio
authors: A
authors: Di Monaco
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Gemma
authors: G
authors: Pelargonio
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy lianarducci@yahoo.it.
authors: Maria Lucia
authors: ML
authors: Narducci
authors: Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy.
authors: Lamberto
authors: L
authors: Manzoli
authors: Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy.
authors: Stefania
authors: S
authors: Boccia
authors: Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy.
authors: Maria Elena
authors: ME
authors: Flacco
authors: Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy.
authors: Lorenzo
authors: L
authors: Capasso
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Lucy
authors: L
authors: Barone
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Francesco
authors: F
authors: Perna
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Gianluigi
authors: G
authors: Bencardino
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Teresa
authors: T
authors: Rio
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Milena
authors: M
authors: Leo
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA Department of Cardiology, University of Foggia, Foggia, Italy.
authors: Luigi
authors: L
authors: Di Biase
authors: Department of Cardiology, University of Foggia, Foggia, Italy Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: Pasquale
authors: P
authors: Santangeli
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
authors: Andrea
authors: A
authors: Natale
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Antonio Giuseppe
authors: AG
authors: Rebuzzi
authors: Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy.
authors: Filippo
authors: F
authors: Crea
mesh_terms: D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D061214:Patient Safety; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology; D014680:Veins
keywords: Cardiac device infection; Cardiac device malfunction; Cardiac endocarditis; Centre volume; Transvenous lead extraction