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Transvenous lead extraction (TLE) has undergone an explosive evolution since its inception as a rudimentary skill with limited technology and therapeutic options. Early techniques involved simple manual traction that frequently proved ineffective for chronically implanted leads and carried a significant risk of myocardial avulsion, tamponade, and death.1 2 The significant morbidity and mortality associated with these early extraction techniques limited their application to life threatening situations such as infection and sepsis. The past 30 years have witnessed significant advances in lead extraction technology resulting in safer and more efficacious techniques and tools, providing the skilled extractor with a well equipped armamentarium. With the development of the discipline, we have witnessed a growth in the community of TLE experts coincident with a pronounced decline in the incidence of procedure related morbidity and mortality, with more recent registries at high volume centres reporting high success rates with exceedingly low complication rates (figure 1).3–6 Future developments in lead extraction are likely to focus on new tools that will allow us to provide comprehensive device management, alternative systems for extraction training, and the design of new leads conceived to facilitate future extraction.
Pathology of the human–lead interaction
The challenges and risks of TLE are principally related to the body's foreign body response to a cardiovascular implantable electronic device (CIED). This …