Electrocautery-assisted Pacemaker Lead Extraction: A Comparative Evaluation of Cutting Versus Coagulation Modes on a...

The increasing use of cardiac implantable electronic devices has led to a rise in transvenous lead extractions (TLEs). The most common indications for TLE are infections and lead malfunction. Over time, leads develop fibrotic encapsulation that makes extraction difficult and increases the risk of myocardial injury. Given the thin myocardial wall, particularly in the right atrial appendage and right ventricular apex, the use of advanced powered tools near the lead tip is contraindicated, posing additional challenges. Electrosurgical energy (EE) has been explored as an adjunct to manual extraction to facilitate safe lead tip removal. This study compares the efficacy and safety of cut and coagulation modes of EE using a porcine tissue model and reports its clinical application in a human case. In the porcine model, the cut mode achieved rapid separation of the lead tip but resulted in deeper tissue penetration. In contrast, the coagulation mode (fulguration setting) enabled controlled dissection with minimal depth of penetration without any collateral injury. The application of the coagulation mode during an actual lead extraction with a dwell time of 8 years in a human patient resulted in complete removal with no postoperative complications. These findings suggest that the coagulation mode of EE offers a safer and more controlled technique for lead tip extraction.