Tandem Approach for Transvenous Lead Extraction: Efficacy, Safety, and Operational Learning Curve

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.