To grade or not to grade safety requirements for transvenous lead extraction: Experience with 2216 procedures.

Background: Transvenous lead extraction (TLE) procedures are now increasingly safe, but there is still a risk of major complications (MC).

Aims: We aimed to assess the impact of TLE organization on the safety of procedures.

Methods: We analyzed 2216 TLE procedures performed in two centers in the years 2006-2021 and compared three organizational procedural models: (1) TLE in an electrophysiology laboratory (EP-LAB) with intravenous analgesia/sedation; (2) TLE with grading of safety requirements (high-risk patients in the cardiac surgery operating theatre, others in EP-LAB); (3) TLE in the hybrid room in all patients under general anesthesia with transesophageal echocardiographic (TEE) monitoring.