Risk stratification in transvenous lead extraction: Current models and clinical applications

Transvenous lead extractions have been increasingly performed in the last decade, in line with the rise in cardiac implantable electronic device implantation. Contemporary transvenous lead extraction registries have demonstrated high procedural success rates and low major complication and mortality rates. However, procedural risk remains highly variable and is dependent on several factors. This highlights the importance of risk stratification to facilitate adequate procedural planning including procedural setting (operating room, hybrid laboratory, or device laboratory), presence of surgical backup, and tools (simple mechanical vs powered sheaths) required. Furthermore, risk stratification allows for upfront decisions to be made regarding lead management (extraction or abandonment) and frank discussions to be had with patients regarding the risk of serious complications and the probability of procedural success. To date, several risk prediction tools have been mooted to predict procedural and/or postprocedural risk, as well as procedural difficulty and need for advanced techniques or tools. In this review, we will summarize and compare the different risk prediction tools available. We will provide practical recommendations on the use of risk prediction tools to improve procedural preparation and minimize mortality from procedural complications.