Techniques for Transvenous Lead Extraction of Cardiac Implantable Electronic Devices: A Network Meta-Analysis

Transvenous lead extraction (TLE) is procedurally complex and carries significant risk. Evidence on optimal TLE techniques is limited and lacks comparative studies.

PubMed, Embase, Cochrane Library, and Web of Science were searched through November 27, 2024. We included randomized clinical trials (RCTs) or non-randomized controlled trials (non-RCTs) comparing two or more TLE methods in adults undergoing lead extraction. A network meta-analysis was conducted to estimate pooled outcomes with 95% CIs. P-scores ranked treatments.

Eleven non-RCTs and one RCT were included. No statistically significant differences were observed in patient-level clinical success or lead-level procedural success. The femoral approach was associated with a significantly lower risk of significant complications compared to the use of laser sheaths (odds ratio, 0.28; 95% CI, 0.09-0.89). Rotating mechanical sheaths (RMS) ranked highest for clinical (p = 0.7470) and procedural success (p = 0.7357), while the femoral approach ranked highest for safety (p = 0.8368). Laser sheaths ranked lowest across all outcomes.

No single technique was superior in terms of success rates. RMS and the femoral approach had the highest rankings for efficacy and safety, respectively. Laser sheaths ranked lowest for both. Rigorous prospective studies with direct comparative analyses are required to establish evidence-based protocols and improve TLE patient outcomes.