Background: Transvenous lead extraction (TLE) is integral to the management of patients with cardiac implantable electronic devices (CIEDs). There are notable procedural risks; however, development of techniques has contributed to an improvement in safety. The mechanical rotational dissecting sheath is safe and efficacious whilst the Needle’s Eye Snare (NES) is an additional ‘bail-out’ strategy. We compared the conventional TLE technique with the ‘Tandem’ procedure.
Methods: The ‘Tandem’ procedure consisted of extraction with the rotational powered sheath from the superior access, in combination with the NES providing countertraction on the lead via the femoral vein. Thirty-seven consecutive ‘Tandem’ procedures (73 targeted leads) performed between 1/12/2021–1/1/2022 in our high-volume TLE institute were matched with 37 conventional TLE procedures (72 leads) (control) using propensity 1:1 score matching. The patients were matched for age, BMI, gender and LVEF.
Results: Compared with the control, the Tandem group had a significantly longer lead dwell time (96 ± 67 months vs 147.3 ± 74 months; p<0.05), requiring a shorter procedure duration (136 ± 64 minutes vs 94 ± 38 minutes; p<0.02), with more fluoroscopy (9.7 ± 8.5 minutes vs 18.6 ± 11.9 minutes; p<0.01). Clinical success was similar between the control and Tandem groups (97% vs 100%; p=0.4) as was complete success (per lead) (95% vs 92%; p=0.7), with a comparable major (5% vs 0%; p=0.4) and minor (0% vs 3%; p=0.57) complication rate; there was no difference in 30-day mortality (3% vs 0%; p=0.4).
Conclusion: The ‘Tandem’ procedure provides an additional strategy to improve the safety and efficacy of TLE, especially in leads of a long dwell time.