Non-laser percutaneous extraction of pacemaker and defibrillation leads: a decade of progress

Aims 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 Evolutionw Mechanical Dilator Sheath and the Evolutionw RL. We sought to determine the impact of new equipment on outcome in mechanical lead extraction. Methods and 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 groupswere identified: Group 1 (pre-Evolutionwperiod, 76 patients, 133 leads), Group 2 (original Evolutionw period, 115 patients, 221 leads), and Group 3 (Evolutionw 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. Conclusion With current equipment, mechanical extraction provides a good combination of efficacy and safety.