Outcome of Percutaneous Cardiac Lead Extraction in Chronically Implanted Leads with Tight Rail Rotating Lead Locking Device

Aims: Despite advances in lead extraction tools, percutaneous lead extraction is a complex procedure associated with morbidity and mortality. No standards or directives exist to guide the choice of extraction tool or approach, and all operators tend to have their preferred method. The data on removing chronically implanted cardiac leads are scarce in India; reporting outcomes with emerging extraction technology is therefore encouraged. This is the first data submitted for the chronic difficult to explant cardiac leads from India. Materials and Methods: Thirteen lead extraction procedures using the Spectranetics tight rail rotating dilator sheath at the tertiary care center over two years are described here. Results: All patients had chronically implanted leads (mean duration 10.4 years), and the pre-procedure venogram showed occluded left subclavian and brachiocephalic veins with extensive collateralization. All leads were extracted successfully using the rotating dilator sheath, and this kit also retained vascular access by venous recanalization. There were no other procedure-related complications, and all patients remained well with suitable lead parameters at 1-year follow-up. Conclusions: The tight rail rotating extraction tool is safe and effective in chronically implanted leads. Moreover, it helps preserve vascular access by recanalizing long tortuous occlusions. Its use across various centers and a larger number of patients will be required to confirm our results.