Summary and general discussion 173 infection. The complete and clinical procedural success rate, and complete lead removal rate was high of all targeted leads. The major procedure-related complication rate was low. We found that an effective and safe TLE procedure can be achieved by using the synergy between a superior and femoral approach. Discussion In part II we focused on the periprocedural and long-term complications associated with CIED therapy, including bleeding complications in patients using oral anticoagulation, the identification of patients at risk of CIED infection and risk of transvenous lead extraction in patients with CIED-related infection or lead dysfunction. Overall, there is a steady increase in the number of implanted pacemakers, ICDs and CRTs in Europe according to the 2017 EHRA white book (40). This can potentially increase the number of associated complications. To improve patient outcome, various factors should be taken into account, including accurate patient selection, optimal implantation technique, and adequate follow-up to timely detect CIED dysfunction. In the past, pre-procedural information was focused on informing patients what to expect during and after the procedure, including short-term complications (within the first year), rather than on device selection (modality), longterm effects, end-of-life care, inappropriate shocks and psychological burden. This has also been recognised by the Dutch government, the Netherlands Society of Cardiology (NVVC), and Dutch society of Cardiovascular Nursing (NVHVV) (41). Uniform patient information materials, with a focus on shared decision-making, benefits and disadvantages of CIED therapy, and care pathways have a functional role. In this respect it is important to encourage patient participation in shared decision making, not only when selecting the preferred treatment (modality), but also involving the patient actively in the follow-up phase as they themselves can provide essential information concerning both prevention and treatment of potential complications when informed thoroughly. When both patients and health care provider achieve consensus on CIED implantation, preoperative assessment should aim to optimise the conditions for implantation regarding patient condition (e.g., afebrile status, allergies, fluid status) and perioperative management of anticoagulation/antiplatelet drugs. To achieve an 10
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