The "No-cut technique" for lead preparation in transvenous lead extraction

Lead fragmentation is a common issue during transvenous lead extraction (TLE) leading to incomplete extraction and prolonged procedural time. Retaining the catheter connector pin has proven to increase the lead tensile strength at bench testing.

This study aimed to investigate the feasibility of systematic connector retention ("No-cut technique" [NCT]) during TLE using powered sheaths.

Consecutive patients undergoing TLE using the stepwise approach at 2 tertiary centers were included. The first center followed a conventional approach based on cutting the catheter connector and using powered sheaths of increasing caliber, if needed. The second center adopted the NCT and systematically used 13F mechanical sheaths. Both centers started TLE with a short mechanical sheath.

445 leads were extracted in 205 patients. Main indications for TLE were infection (66%) and lead malfunction (25%). The NCT group included 111 patients (54%), of whom 223 leads (99%) were successfully extracted. Compared with the conventional approach group, the NCT group reported a higher rate of complete procedural success (97% vs 92%; P = .017), a similar rate of clinical success (98% vs 97%; P = .501), and a lower rate of lead fragmentation (4% vs 11%; P = .027). Lower fluoroscopy use (P < .001) and shorter laboratory time (P < .001) were also noted. Major complications were 5 (2%; P = .520) without deaths. Overall, 1-year survival was 98% (P = .627).

NCT reported a higher rate of complete lead extraction, a lower rate of lead fragmentation, and better laboratory time without increased complications.