Lead extraction and contrast venography.

To the Editor,

Manolis et al. (1) reported that percutaneous lead extraction can be successful with mechanical tools using the lead-locking device (LLD) stylet. In this prospective observational clinical study, they showed us that leads were successfully removed using simple traction and LLD stylets aided with telescoping sheaths.

Implantation of permanent pacemakers has increased with emerging technologies and use of implantable cardioverter defibrillator and cardiac resynchronization therapies (2). The increased number of device implantation and prolonged survival has led to the increase in the number of lead revision procedures. There are different lead extraction techniques that can be successfully performed in many centers. One of the mechanical lead extraction systems is the LLD system. LLD allows transmitting the manipulation to the distal tip of the lead, thereby protecting the lead integrity. However, venous stenosis may reduce the success of the procedure.

In this well-presented article by Manolis et al., it was demonstrated that lead extraction with the LLD system is simple, safe, and inexpensive with mechanical tools and local anesthesia. However, there is no preprocedural data about contrast venography. The incidence of venous stenosis after transvenous implantation of a pacemaker varies between 20% and 50% (3,4). Showing the venous course using a small amount of contrast may eliminate most of the difficulties (5). In the light of this knowledge, it might be beneficial to know whether contrast venography was performed before extraction.