Lead extractions: dissecting adhesions up to the lead-tip of the right
ventricle: safety and success-rates
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.