Non-laser percutaneous extraction of pacemaker and defibrillation leads: a decade of progress.
OBJECTIVE
Non-laser-based methods are safe in lead extraction but in the past have been less effective than laser methods. In the past decade, new equipment has been introduced including the Evolution® Mechanical Dilator Sheath and the Evolution® RL. We sought to determine the impact of new equipment on outcome in mechanical lead extraction.


RESULTS
We considered 288 consecutive patients (age 66 ± 18 years) who underwent transvenous lead extraction (TLE) of 522 leads in the decade to the end of 2014. Three groups were identified: Group 1 (pre-Evolution® period, 76 patients, 133 leads), Group 2 (original Evolution® period, 115 patients, 221 leads), and Group 3 (Evolution® RL period, 97 patients, 168 leads). The age of leads was significantly greater in Groups 2 and 3 (6.2 ± 4.4 and 6.1 ± 5.4 years vs.4.7 ± 4.5, P < 0.05) as was the proportion of implantable cardioverter defibrillator leads (27.2 and 28.9 vs. 14.3%, P < 0.05). The groups were similar in the number of leads extracted per patient. Despite the increasing complexity of the systems extracted, complete extraction was achieved in a progressively greater proportion of leads (88.0% in Group 1, 95.5% in Group 2, and 97.6% in Group 3, P < 0.05), and procedure duration was similar. The proportion of leads for which femoral access was required was greater in Group 3 (11%, 18/164) compared with Group 2 (3%, 7/211), P = 0.006. The only major complications were a post-procedure subacute tamponade in Group 1 and an oesophageal injury related to transoesophageal echocardiography in Group 3.


CONCLUSIONS
With current equipment, mechanical extraction provides a good combination of efficacy and safety.
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Giulia
G
Domenichini
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Hanney
H
Gonna
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Rajan
R
Sharma
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Sergio
S
Conti
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Lorenzo
L
Fiorista
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Sue
S
Jones
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Maria
M
Arthur
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Shaumik
S
Adhya
Department of Cardiac Surgery, St. George's Hospital, London SW17 0QT, UK.
Marjan
M
Jahangiri
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Edward
E
Rowland
Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's University of London, London, UK.
Mark M
MM
Gallagher
D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D062906:Cardiac Catheters; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D061214:Patient Safety; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Evolution® RL; Evolution® mechanical dilator sheath; ICD lead extraction; ICD leads; Pacemaker lead extraction; Transvenous mechanical lead extraction