Non-laser percutaneous extraction of pacemaker and defibrillation leads: a decade of progress

• Published in: Europace (London, England) England), 2017-09, Vol.19 (9), p.1521-1526
• Main Authors: Domenichini, Giulia, Gonna, Hanney, Sharma, Rajan, Conti, Sergio, Fiorista, Lorenzo, Jones, Sue, Arthur, Maria, Adhya, Shaumik, Jahangiri, Marjan, Rowland, Edward, Gallagher, Mark M
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Catheterization - methods; Cardiac Catheterization - trends; Cardiac Catheters; Defibrillators, Implantable; Device Removal - adverse effects; Device Removal - instrumentation; Device Removal - methods; Device Removal - trends; Diffusion of Innovation; Female; Humans; Male; Middle Aged; Pacemaker, Artificial; Patient Safety; Prosthesis Design; Prosthesis Failure; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euw162

Non-laser-based methods are safe in lead extraction but in the past have been less effective than laser methods. In the past decade, new equipment has been introduced including the Evolution® Mechanical Dilator Sheath and the Evolution® RL. We sought to determine the impact of new equipment on outcome in mechanical lead extraction. We considered 288 consecutive patients (age 66 ± 18 years) who underwent transvenous lead extraction (TLE) of 522 leads in the decade to the end of 2014. Three groups were identified: Group 1 (pre-Evolution® period, 76 patients, 133 leads), Group 2 (original Evolution® period, 115 patients, 221 leads), and Group 3 (Evolution® RL period, 97 patients, 168 leads). The age of leads was significantly greater in Groups 2 and 3 (6.2 ± 4.4 and 6.1 ± 5.4 years vs.4.7 ± 4.5, P < 0.05) as was the proportion of implantable cardioverter defibrillator leads (27.2 and 28.9 vs. 14.3%, P < 0.05). The groups were similar in the number of leads extracted per patient. Despite the increasing complexity of the systems extracted, complete extraction was achieved in a progressively greater proportion of leads (88.0% in Group 1, 95.5% in Group 2, and 97.6% in Group 3, P < 0.05), and procedure duration was similar. The proportion of leads for which femoral access was required was greater in Group 3 (11%, 18/164) compared with Group 2 (3%, 7/211), P = 0.006. The only major complications were a post-procedure subacute tamponade in Group 1 and an oesophageal injury related to transoesophageal echocardiography in Group 3. With current equipment, mechanical extraction provides a good combination of efficacy and safety.