CVM Cardiovascular Medicine 1664-204X 1664-2031 EMH Schweizerischer Ärzteverlag AG Farnsburgerstrasse 8 CH-4132 Muttenz 02224 10.4414/cvm.2022.02224 Original article Arrhythmias Impact of a structured institutional lead management programme at a high volume centre for transvenous lead extractions in Switzerland Haeberlin Andreas andreas.haeberlin@insel.ch Bern University Hospital | Department of Cardiology | Bern | SWITZERLAND Holz Alexander Seiler Jens Baldinger Samuel H. Tanner Hildegard Roten Laurent Madaffari Antonio Servatius Helge Jenni Hansjörg Kadner Alexander Erdoes Gabor Reichlin Tobias Noti Fabian 01 09 2022 25 05 0 0 Copyright: EMH Schweizerischer Ärzteverlag AG 2022 EMH Schweizerischer Ärzteverlag AG "Cardiovascular Medicine" is an open access publication of EMH published in accordance with the terms of the Creative Commons licence attribution - NonCommercial - NoDerivatives 4.0 International. You are free to share, copy and redistribute the material in any medium or format under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. NonCommercial — You may not use the material for commercial purposes. NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material. "Non-commercial" means not primarily intended for or directed towards commercial advantage or monetary compensation. The incorporation of publications in commercial products, the use of publications to advertise for commercial products or services and any other usage that directly or indirectly pursues commercial interests is subject to the express previous consent of the publishing house as part of a written agreement. Please send us your request in writing. Exact indication of the publication from which you would like to reproduce material and detailed information about its intended use help to facilitate and expedite request processing.

Background: Transvenous lead extraction (TLE) is the recommended management strategy for a variety of cardiac implantable electronic device (CIED) infections, malfunctions, and other conditions. Large registries have established the safety and efficacy of TLE per se but temporal outcome data after the introduction of an institutional lead management program remain scarce. Objective: To investigate the impact of a structured institutional lead management program on TLE outcomes. Methods: All patients who underwent TLE at our institution between 01/2013 and 12/2020 were included. We assessed procedural outcomes after TLE for two separate timeframes: from 01/2013-12/2018 and 01/2019-12/2020 (after introduction of a structured institutional lead management program). Results: In 2013-2018, the median number of TLE procedures per year at our center was 14 (range 10-19, total 84). In 2019/2020, the median number of interventions per year increased to 46 (range 41-51, total 92). Non-infectious indications for TLE became more frequent (p<0.001), while the proportion of TLE due to infections decreased. Median lead dwell time was not different (4.3 years [2013-2018] vs. 4.4 years [2019-2020], p=0.43). Clinical success rates improved from 90% to 98% (p=0.020) and complete procedural success increased from 85% to 95% (p=0.027). There was a trend towards a lower number of TLE-associated complications (p=0.07). Conclusion: A structured institutional lead management program and increasing experience significantly improve TLE outcomes. TLE can be safely performed in high-volume centers, allowing for a more liberal extraction policy also in the case of non-infectious TLE indications.