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Introduction: The prevalence and impact of pulmonary embolism (PE) in patients with lead‐related infective endocarditis undergoing transvenous lead extraction (TLE) are unknown. Methods: Twenty‐five consecutive patients with vegetations ≥10 mm at transoesophageal echocardiography were prospectively studied. Contrast‐enhanced chest computed tomography (CT) was performed before (pre‐TLE) and after (post‐TLE) the lead extraction procedure. Results: Pre‐TLE CT identified 18 patients (72%) with subclinical PE. The size of vegetations in patients with PE did not differ significantly from those without (median 20.0 mm [interquartile range: 13.0–30.0] vs. 14.0 mm [6.0–18.0], p = 0.116). Complete TLE success was achieved in all patients with 3 (2–3) leads extracted per procedure. There were no postprocedure complications related to the presence of PE and no differences in terms of fluoroscopy time and need for advanced tools. In the group of positive pre‐TLE CT, post‐TLE scan confirmed the presence of silent PE in 14 patients (78%). There were no patients with new PE formation. Large vegetations (≥20 mm) tended to increase the risk of post‐TLE subclinical PE (odds ratio 5.99 [95% confidence interval (CI): 0.93–38.6], p = 0.059). During a median 19.4 months follow‐up, no re‐infection of the implanted system was reported. Survival rates in patients with and without post‐TLE PE were similar (hazard ratio: 1.11 [95% CI: 0.18–6.67], p = 0.909). Conclusion: Subclinical PE detected by CT was common in patients undergoing TLE with lead‐related infective endocarditis and vegetations but was not associated with the complexity of the procedure or adverse outcomes. TLE procedure seems safe and feasible even in patients with large vegetations. [ABSTRACT FROM AUTHOR]

Introduction A lead extraction difficulty (LED) score was proposed to predict the difficult transvenous lead extraction (TLE) procedures, defined by means of the fluoroscopy time. The aim of this study was to validate the estimation model based on the LED index above 10 on an independent data set of TLE cases. Methods Consecutive patients undergoing TLE between January 2014 and January 2016 were included in this analysis. The fluoroscopy time related to the leads removal was dichotomized as above or below its 90th percentile (PCTL). Results In total, 446 permanent leads were removed during 233 TLE procedures. Complete procedural success was achieved in 232 (99.1%) patients. The LED index resulted >10 in 83(35.6%) procedures. Among these cases, 20 had fluoroscopy time above the 90th PCTL (23.3 minutes) and were classified as true positive. Over the 150 procedures with LED score <10, 147 were classified as true negative, and only 3 resulted false negative. The sensitivity, the specificity, and the negative predictive value of the LED index in predicting complex cases resulted 86.9 (confidence interval [CI] 66.4-97.2)%, 70.0 (CI 63.3-76.1)%, and 98.0 (CI 94.3-99.6)%, respectively. The multivariate logistic regression analysis confirmed a 12% increased risk of high fluoroscopy for each additional point of the LED score (OR 1.12, CI 1.05-1.21, P = 0.001). Conclusion The validation of the estimation model based on the LED index <10 confirmed its high efficacy in predicting simple TLE procedures. [ABSTRACT FROM AUTHOR]