Key result
Rotational mechanical dilator sheaths are effective tools for transvenous lead extraction, particularly for dissecting heavily calcified fibrous adhesions, with high procedural success rates and low complication rates.
Why the study?
Transvenous lead extraction is challenging in the presence of heavily calcified fibrous adhesions, requiring thorough knowledge of rotational mechanical dilator sheaths to increase procedural success and reduce complications.
Rotational mechanical dilator sheaths are effective tools for facilitating transvenous lead extraction, particularly for overcoming calcified adhesions, but require careful use in patients with older leads.
An exponential rise in clinical demand for cardiac implantable electronic device (CIED) therapy is observed all over the world due to the rapidly expanding lifespan. Accordingly, appropriate lead management including lead extraction is becoming increasingly essential components for the comprehensive care of patients with various CIEDs. With a high success rate and a low complication rate, transvenous lead extraction (TLE) has now been established as first-line therapy for lead extraction. However, TLE is often challenging when there are heavily calcified fibrous adhesions between leads and cardiovascular structures. Recently, rotational mechanical dilator (RMD) sheaths were introduced to resolve this issue and facilitate TLE procedure. There are two types of commercially available RMD sheaths, Evolution® systems and TightRail™. Thorough knowledge of the proper use of the RMD devices is essential to increase success rate and to reduce complications of TLE. In the present review, mechanical features, various techniques, and clinical data of RMD sheaths will be described. According to recent advancement of device technology, the clinical outcomes of TLE using the RMD sheaths are continuously improving. However, as the RMD sheath is a potentially aggressive tool, special care should be taken when used in patients with longer lead ages.
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Park et al. (2022) conducted a review in Cardiac implantable electronic device (CIED) lead extraction. Rotational mechanical dilator (RMD) sheaths was evaluated. Rotational mechanical dilator sheaths are effective tools for transvenous lead extraction, particularly for dissecting heavily calcified fibrous adhesions, with high procedural success rates and low complication rates.
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