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Related Experiment Video

Updated: Jan 9, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Tandem Approach for Transvenous Lead Extraction: Efficacy, Safety, and Operational Learning Curve.

Alessio Petrone1, Zaki Akhtar1, Christos Kontogiannis1

  • 1Cardiology Clinical Academic Group, City St George's University Hospital, NHS Foundation Trust, London, UK.

Journal of Cardiovascular Electrophysiology
|December 9, 2025
PubMed
Summary
This summary is machine-generated.

The Tandem approach, combining superior and femoral access, is a safe and effective primary strategy for complex transvenous lead extraction (TLE). It demonstrates high procedural success and complete lead removal rates, though resource intensity and operator experience are considerations.

Keywords:
Needle's eye femoral snareoperational learning curvepredictors of efficacy and safetytandem approachtransvenous lead extraction

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Transvenous lead extraction (TLE) demand is increasing due to higher rates of cardiovascular device implantation and an aging population.
  • While superior access is standard for TLE, the Tandem approach offers a potential alternative for complex cases.
  • The Tandem approach combines femoral and superior venous access to enhance efficacy and safety during TLE procedures.

Purpose of the Study:

  • To evaluate the outcomes of the Tandem approach as a primary strategy for transvenous lead extraction.
  • To identify predictors of success and complications associated with the Tandem TLE approach.
  • To assess the learning curve associated with the Needle's Eye Snare (NES) in the context of Tandem TLE.

Main Methods:

  • A retrospective analysis of 148 patients undergoing Tandem TLE at a high-volume UK center from September 2020 to December 2024.
  • Data collected included procedural success, complete lead removal, complication rates, and outcome predictors.
  • Fluoroscopy time was used to assess the learning curve for the Needle's Eye Snare (NES).

Main Results:

  • The Tandem approach was used for 81.2% of 319 targeted leads, achieving 97.3% clinical procedural success and 93% complete lead removal.
  • Medtronic leads were the sole independent predictor of complete lead removal.
  • Major complications occurred in 3.4% of cases; BMI < 25 kg/m² and extraction of ≥ 3 leads predicted complications and 30-day mortality. NES proficiency improved significantly after 40 leads.

Conclusions:

  • The Tandem approach is a safe and effective primary strategy for complex TLE, especially for leads with passive fixation, shock capability, and long dwell times.
  • Potential limitations to widespread adoption include resource intensity, increased fluoroscopy exposure, and the requirement for experienced operators.
  • The study confirms a learning curve for NES proficiency, emphasizing the need for specialized training.