The Needle's Eye Snare as a primary tool for pacing lead extraction

The femoral approach for lead extraction is typically used as a bailout procedure. We describe the results of a femoral approach with a Needle's Eye Snare and Femoral Workstation as a primary tool for extracting pacing leads.

Four hundred and seventy-six pacing leads implanted for >6 months were extracted in 229 consecutive patients (178 male, age 70.4 ± 12.7 years). First, traction was performed with a standard stylet, and if unsuccessful this was followed by the femoral approach with a Needle's Eye Snare. Traction sufficed for 136 leads and a femoral approach was required in 340 leads, their respective implant times were 3.7 ± 2.9 and 9.2 ± 5.8 years. The Needle's Eye Snare failed or was only partial successful (leaving a lead remnant of <4 cm) in, respectively, 1.8 and 3.8% of all leads, 2.7 and 7.1% of 182 right ventricular, 0.7 and 0% of 144 atrial leads, and in none of 14 coronary sinus leads. All leads implanted for <10 years were removed with a clinical success. Two patients were successfully operated after pericardial tamponade. There were no procedure-related deaths.

Needle's Eye Snare lead extraction has a low complication rate. The technique should be considered as a primary tool for extraction of pacing leads, particularly atrial and coronary sinus pacing leads. The results for extracting ventricular leads might be improved if larger bore sheaths with a better cutting edge were available.