Lead Extraction: The Importance of Preparation and Remaining Opportunities

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Lead extraction procedures are the most challenging procedures facing invasive electrophysiologists. The sheer mortality burden of these procedures as a result of complications in the periprocedural period is unparalled. The benefits attributable to a successful procedure, however, justify the risks taken to perform it. Given the high stakes, preprocedural planning is unequivocally mandatory prior to attempting the procedure. It remains a collaborative effort between the electrophysiology (EP) team, the cardiac surgery team, and the anesthesia team. Everyone has to be aware of the possible outcomes. The protocol to deal with each one has to be formalized and discussed prior to every case attempted.
Bontempi et al.1 report their experiences with a hybrid laser lead extraction protocol, used in high‐risk patients, aimed at diagnosing complications and intervening at the earliest. They used thoracotomy and thoracoscopy in an attempt to avoid routine use of cardiopulmonary bypass. This is a minimally invasive approach compared to previously reported protocols.
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