Incidence and Predictors of Successful Lead Extraction With Short Active Mechanical Extraction Sheaths Only
Caroline Wiederkehr1,2, Noah Kuster2, Michelle Bebié2
1Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
Background And Aims:
Transvenous lead extraction (TLE) is increasingly performed for malfunction or infection of cardiac implantable electronic devices (CIED). Active mechanical rotational sheaths facilitate extraction and are available in short and long sizes, but it is unclear how many patients short active mechanical extraction sheaths (SAMES) are sufficient for TLE, and in which patients they may facilitate TLE. This study aimed to evaluate the incidence and predictors of successful lead extraction using only SAMES.
Methods:
We retrospectively analyzed patients who underwent TLE at the University Hospital Zurich from 2013 until 2023 regarding the use of short or long active mechanical extraction sheaths, as well as clinical and radiological success and complications.
Results:
A total of 568 TLEs were performed from January 2013 until December 2023. In 55 cases (9.7%), TLE was successful using only SAMES. Independent predictors for successful lead extraction using only SAMES in multivariate analysis were shorter lead dwell time (OR: 0.98, 95% CI: 0.97-0.99, p < 0.001) and use of anticoagulation (OR: 0.44, 95% CI: 0.19-1.00, p = 0.05). Complications occurred at a lower rate when only SAMES were used (All complications 12.7% vs. 24.2%, minor complications 9.1% vs. 18.7%, perioperative death 0% vs. 1.7%).
Conclusion:
In 10% of patients undergoing TLE, SAMES are sufficient for successful lead extraction. SAMES may be a sensible choice as the primary extraction tool in patients with chronic anticoagulation and shorter lead dwell time, as these factors predict a higher likelihood of success in TLE with SAMES only.
