title: Lead extraction: The road to successful cardiac resynchronization therapy.
abstract: BACKGROUND
  Still increasing life expectancy in patients with implanted devices and large number of leads more and more often induce the need to cure the treatment complications or to change especially to cardiac resynchronization therapy (CRT). In order to prevent further complications, the possibility of damaged or redundant leads extraction should be taken into consideration. The aim of the paper was to assess the effectiveness and safety of transvenous lead extraction (TLE) with co-implantation of resynchronization systems.
  
  
  RESULTS
  Between 2008 and March 2013, the system removal with TLE was conducted in 246 patients. In 38 patients (11 women, 28.9%), aged 43-79 (mean 65 years), it was combined with co-implantation of CRT-pacemaker or defibrillator (CRT-P/D). Indications for TLE covered: lead failure in 21 (55.3%) patients, redundant leads in 6 (15.8%), and the occluded venous system in 7 (18.4%). The up-grade of the pacemaker or defibrillator system to CRT-D was performed in 19 cases, CRT-P/D revision in next 19. Together 32 defibrillation leads and 42 pacing leads (27 left ventricular leads, and 1 epicardial lead) were implanted. The intended clinical target--an effective resynchronization therapy--was obtained in all patients. There was no case of death or severe complications. In 2 cases of venous occlusion, the implantation on the contralateral side was required.
  
  
  CONCLUSIONS
  TLE enables effective resynchronization therapy also in the case of the presence of too many leads, occlusion of the venous system or lead failure. Significant technical problems can occur especially in patients with venous system occlusion.
authors.affiliation: 2nd Coronary Disease Depar tment, Institute of Car diology, Warsaw, Poland. maciag_o@poczta.onet.pl.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Maciąg
authors.forename: Paweł
authors.initials: P
authors.lastname: Syska
authors.forename: Maciej
authors.initials: M
authors.lastname: Sterliński
authors.forename: Andrzej
authors.initials: A
authors.lastname: Przybylski
authors.forename: Ewa
authors.initials: E
authors.lastname: Sitkowska
authors.forename: Artur
authors.initials: A
authors.lastname: Oręziak
authors.forename: Maria
authors.initials: M
authors.lastname: Bilińska
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kuśmierczyk
authors.forename: Hanna
authors.initials: H
authors.lastname: Szwed
mesh_terms: D000328:Adult; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects; D017147:Defibrillators, Implantable / Q000009:adverse effects; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome