title: Leads dislodged into the pulmonary vascular bed in patients with cardiac implantable electronic devices.
abstract: BACKGROUND
  Spontaneous lead dislodgement into the pulmonary circulation is a rare complication of permanent pacing with unproven harmfulness and an indication of controversial class for transvenous lead extraction (TLE).
  
  
  OBJECTIVE
  To assess TLE safety in patients with leads dislodged into the pulmonary artery.
  
  
  METHODS
  A retrospective analysis of a 9-year-old database of transvenous lead extraction procedures comprising 1767 TLEs was carried out, including a group of 19 (1.1%) patients with leads dislodged into the pulmonary artery (LDPA).
  
  
  RESULTS
  Under univariate analysis the factors that increased the likelihood of the presence of an electrode in the pulmonary artery were mean lead dwelling time (increase of risk by 9% per year), total number of leads in the heart before TLE (increase of risk by 66% for one lead) and the number of abandoned leads (increase of risk by 119%). The presence of LDPA was associated with frequent occurrence of intracardiac lead abrasion (increase by 316%) and isolated lead-related infective endocarditis (LRIE) (increase by 500%). There were no statistically significant differences in clinical (p= 0.3), procedural (p= 0.94) or radiological (p= 0.31) success rates in compared (LDPA and non-LDPA) groups. Long-term mortality after TLE was comparable in both groups.
  
  
  CONCLUSIONS
  As the effectiveness and safety of TLE in patients with LDPA are comparable to those in standard TLE procedures, in our opinion, such patients should be considered TLE candidates.
authors.affiliation: Acute Cardiac Care Unit, Swietokrzyskie Cardiology Centre, Kielce, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Polewczyk
authors.affiliation: 2 Department of Cardiology, Silesian Medical University, Zabrze, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jacheć
authors.affiliation: 1 Department of Paediatrics, District Hospital, Kielce, Poland.
authors.forename: Aneta M
authors.initials: AM
authors.lastname: Polewczyk
authors.affiliation: Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Polewczyk
authors.affiliation: Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Czajkowski
authors.affiliation: Department of Cardiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kutarski
keywords: intracardiac lead abrasion; lead dislodgement; transvenous lead extraction