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.