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Lead extractions: dissecting adhesions up to the lead-tip of the right ventricle: safety and success-rates
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  • Olivier Witte,
  • Peter Delnoy,
  • Abdul Ghani,
  • Jaap Jan Smit,
  • Anand Ramdat Misier,
  • Arif Elvan,
  • Ahmet Adiyaman
Olivier Witte
Isala Klinieken

Corresponding Author:[email protected]

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Peter Delnoy
Isala klinieken
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Abdul Ghani
Isala Klinieken
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Jaap Jan Smit
Isala Klinieken
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Anand Ramdat Misier
Isala Klinieken
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Arif Elvan
Isala Klinieken
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Ahmet Adiyaman
Isala Klinieken
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Abstract

Objectives and Background: Goal of Transvenous Lead Extraction (TLE) is complete removal of all targeted leads, without complications. Despite counter traction manoeuvres, efficacy rates are often hampered by broken right ventricle lead (RV-lead) tips. Mechanically powered lead extraction (Evolution sheath) is effective, however safety of dissection up to the lead tip is unclear. Therefore, we examined the feasibility and safety of RV-lead extraction requiring dissection up to the myocardium. Methods and results: From 2009 to 2018, all TLE in the Isala Heart Centre (Zwolle, The Netherlands) requiring the hand-powered mechanical Evolution system to extract RV-leads (n=185) were examined from a prospective registry. We assessed 2 groups: TLE with the first generation Evolution (n=43) with (A1,n=18) and without (A2,n=25) adhesions up to the myocardium and TLE with the Novel R/L type (n=142) of sheath with (B1,n=59) and without (B2,n=83) adhesions up to the myocardium. Complete success rate in Group B was significantly higher than group A (96.5 vs 76.7%, p=0.0354). When comparing the patients with adhesions up to the myocardium, total complete success is higher in the R/L group (61.1% vs 90.5%, p=0.0067). There were no deaths. Overall major complication rates were low (2/185;1.1%) and there was no statistically significant difference in major and minor complications between the two groups. Conclusion: Extraction strategy with the bidirectional Evolution R/L sheath for right ventricular leads with adhesions up to the myocardium is safe and feasible.
16 Dec 2021Published in Pacing and Clinical Electrophysiology. 10.1111/pace.14416