Introduction
Transvenous lead extraction (TLE) is considered first-line strategy for the management of complications associated with cardiac implantable electronic devices (CIED) [1,2]. Recently, due to the rising incidence of infectious and non-infectious CIED-related complications, the number of TLE has also been increasing [3]. According to numerous reports, the frequency of major complications of TLE ranges from 0.9 to 4.0%, and most often there is damage to the heart or venous vessels [4-7]. Assessment of risk factors for major complications and procedure complexity should have an impact on the selection of a suitable organizational model of the procedure and center preferment [4-7]. The available TLE risk stratification scales most often take into account the impact of various factors on the technical complexity of the procedure [4-7] or periprocedural mortality [4-7]. They are based on demographic and clinical data (patient age, gender, presence of co-morbidities ), type of CIED system (ICD lead, number of leads) and history of pacing (age at first implantation, number of leads designed for extraction) [4-7]. This is the first study to assess the usefulness of new factors that may significantly affect the level of difficulty and procedure complexity as well as efficacy and complications of TLE. These factors were identified during an echocardiographic examination of patients selected for TLE due to CIED-related complications. Echocardiography, especially transesophageal echocardiography plays a key role in the evaluation of rhythm controlling devices (PM/ICD/CRT) and remains a valuable tool for precise imaging, which is recommended by experts [8-15]. Although a number of studies focused on the value of preoperative TEE findings (size of vegetations, presence of asymptomatic masses on the leads), the only echocardiographic parameter discussed when estimating the procedure-related risk was left ventricular ejection fraction (LVEF), only few studies so far have suggested that TEE can be used apart from fluoroscopy or computerized tomography [7] to choose optimal TLE strategy [16,17], nevertheless the effect of echocardiographic findings on procedure safety and efficacy has not been assessed.