Key result
A mechanical approach for transvenous lead extraction resulted in a higher clinical success rate compared to a laser approach.
Why the study?
Does a laser approach compared to a mechanical approach improve clinical and procedural success in patients undergoing transvenous lead extraction?
Observational (n=122)
Does a laser approach compared to a mechanical approach improve clinical and procedural success in patients undergoing transvenous lead extraction?
For transvenous lead extraction of long-implanted leads, the mechanical approach offers higher clinical success and better cost-effectiveness compared to the laser approach, with comparable procedural success and safety.
Answers are grounded in this paper and cite their sources.
Mechanical approach may yield higher success in lead extraction; hypothesis-generating and should not yet change practice without RCTs.
AIMS: In this retrospective study we compared different lead extraction techniques. METHODS AND RESULTS: Between January 2009 and December 2012 we performed transvenous lead extraction procedures on 206 leads in 122 patients. Mean implant duration (MID) was 69.6 months (1-384 months). Leads with lead implant duration ≥ 12 months were assigned to groups according to the extraction technique: Group A: no extraction tool; Group B: laser approach; and Group C: mechanical approach. Overall clinical success was 93.3%. Group A showed a significantly lower MID [38.1 (19-122) months] compared with Groups B and C [83.1 (13-168) months; P < 0.0001 vs. 95.4 (12-384) months; P < 0.0001]. Mean implant duration between Groups B and C did not differ significantly (P = 0.28). Clinical and complete procedural success was 100% in Group A. Clinical success rate was higher in Group C than in Group B (97.0 vs. 76.9%, P = 0.018). Complete procedural success did not differ significantly between Groups B and C (88.9 vs. 76.9%; P = 0.132). In Groups B and C, absence of complete procedural success occurred in long implanted leads (MID 107.8 ± 36.4 and 137.6 ± 89.2 months). Relative costs per extracted lead were 49% higher in Group B than in Group C. CONCLUSION: In case of long implanted leads a laser and a mechanical approach are comparable in complete procedural success and safety. Clinical success and cost effectiveness analysis favours the mechanical approach. Regardless of the extraction technique efficacy and safety optimization has to focus on long implanted leads.
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Starck et al. (2013) conducted an observational in Transvenous lead extraction (n=122). Mechanical approach vs. Laser approach was evaluated on Clinical success (p=0.018). A mechanical approach for transvenous lead extraction resulted in a higher clinical success rate compared to a laser approach.
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