A simplified method of lead snaring to facilitate a tandem approach for long-dwelling transvenous lead extractions

BACKGROUND: Increasingly, transvenous lead extractions (TLEs) have become more complex. OBJECTIVE: This study aimed to describe a novel technique for femoral snaring using commercially available equipment and study the application of this technique for a tandem approach in TLE cases with long-dwelling leads compared with conventional TLE. METHODS: We include 59 patients with long-dwelling transvenous leads who underwent powered sheath TLE with either upfront femoral snaring (n = 25) or conventional approach (n = 34). Our femoral snaring technique uses a grasping device within telescoped sheaths creating a rail for powered sheath advancement and lead dissection. Clinical and procedural data were obtained via manual electronic medical record review. RESULTS: Among our study cohort, 74.6% were men, the mean age was 66.1 ± 16.8 years, 57.6% were pacemaker dependent, 72.9% underwent TLE for infection, and the mean dwell time was 15.0 ± 4.7 years. The mean number of cardiac implantable electronic device leads and implantable cardioverter-defibrillator coils was 2.3 ± 1.0 and 1.8 ± 0.8, respectively. Compared with controls, intervention patients were older (72.5 ± 11.4 years vs 61.4 ± 18.6 years; P < .01) and more likely to have ischemic cardiomyopathy (52.0% vs 29.4%; P = .04), lower left ventricular ejection fraction (41.8% ± 15.7% vs 49.8% ± 11.8%; P = .02), hypertension (84.0% vs 61.8%; P = .03), diabetes (76.0% vs 14.7%; P < .01), and right-sided leads (28.0% vs 2.9%; P < .01). No significant differences were observed in procedure or fluoroscopy times with a signal of lower complication rate among the intervention group. The only procedural mortality occurred in the control group. CONCLUSION: We describe a novel upfront tandem TLE technique using commercially available items applied to long-dwelling leads. This technique was safe and effective compared with contemporary controls.