INTRODUCTION
In parallel to the increased use of cardiac implantable electronic
devices (CIED), the electrophysiology society is faced with
device-related problems like device upgrade, device-related infection,
electrode dysfunction, and dislodgement, which should be managed with
valid and reliable methods 1. Despite significant
improvement over the last decade in transvenous lead extraction (TLE)
technology and low TLE related mortality at high-volume centers, the
postprocedural and long-term mortality remain high in specific patient
subgroups, including those undergoing TLE for infectious indications and
device system upgrade 2.
After implantation, transvenous leads are often encapsulated with
fibrotic capsules which adhere to vascular and intra-cardiac tissue by
different humoral and cellular mechanisms 1. Among
various tools and methods, powered extraction devices are required to
remove the chronically implanted leads 3. Rotational
mechanical dilator sheaths are acting by dissection of the fibrotic
tissue in which the electrodes connected using the threaded end portion
of the system 4. Currently, two different mechanical
dilator sheaths with variable technical properties are available in the
market [Evolution® (Cook Medical, Bloomington, IN,
USA) and TightRailTM (Spectranetics Corp., Colorado
Springs, Colorado, USA) mechanical dilator sheaths]. Both the TLE
system revealed high efficacy rates and acceptable safety results3,5. However, the comparative data are scarce among
different types of powered extraction tools. Previous studies have
presented the data of single TLE device in general5,6. There is only one small study regarding the
comparison of different rotational mechanical dilators7.
Thus, we aimed to compare the safety and efficacy outcomes and all-cause
mortality at long-term follow-up in a large-scale study population who
underwent TLE using two different rotational mechanical dilators
sheaths.