Electrocautery-assisted Pacemaker Lead Extraction: A Comparative Evaluation of Cutting Versus Coagulation Modes on a Porcine Muscle Model with Clinical Translation.

Q: What is the clinical evidence from this study?

Population: Chronically implanted pacemaker/defibrillator lead requiring extraction (porcine model and clinical case) (n=1). Intervention: Electrosurgical energy in coagulation mode vs. Electrosurgical energy in cut mode (preclinical) / manual traction (clinical). Primary outcome: Efficacy of lead separation and safety regarding collateral tissue injury.

MallikarjunaN Reddy; Daljeet Kaur Saggu; Muthiah Subramanian; Sachin Dhareppa Yalagudri; Dinakar Bootla; Sridevi Chennapragada; Prabhakar Reddy; Calambur Narasimhan

doi:10.19102/icrm.2026.17086

August 1, 2026Open Access

Electrocautery-assisted Pacemaker Lead Extraction: A Comparative Evaluation of Cutting Versus Coagulation Modes on a Porcine Muscle Model with Clinical Translation.

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Key result

Coagulation-mode electrosurgical energy enables safe lead tip separation without collateral injury during extraction.

n=1

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Why the study?

The increasing use of cardiac implantable electronic devices has led to more transvenous lead extractions, with challenges in safe lead tip removal due to fibrotic encapsulation and thin myocardial walls.

Does electrosurgical energy in coagulation mode safely facilitate pacemaker lead tip extraction without collateral tissue damage compared to cut mode in a preclinical model?

Key Points

To compare the safety and efficacy of cutting versus coagulation modes of electrosurgical energy for pacemaker lead extraction in a porcine tissue model and assess clinical translation.
Tested monopolar electrocautery in cut and coagulation (fulguration) modes on tined and screw-in pacemaker leads embedded in a thin porcine muscle sheet model.
Translated the optimal electrosurgical energy setting to a 55-year-old male patient requiring extraction of an encapsulated right ventricular defibrillator lead with an 8-year dwell time.
In the porcine model, cut mode achieved separation after two cycles but caused tissue perforation, tunneling, and collateral damage across the tissue.
Coagulation mode released the screw-in lead after three cycles and separated tined leads without tissue perforation, tunneling, or collateral injury.
Clinical application using coagulation mode at 25 W for two 2-second cycles enabled complete removal of the chronic lead without intraoperative or postoperative complications.

Structured PICO

Does electrosurgical energy in coagulation mode safely facilitate pacemaker lead tip extraction without collateral tissue damage compared to cut mode in a preclinical model?

P

Population

Preclinical porcine muscle model combined with a single 55-year-old male patient requiring extraction of a chronically implanted defibrillator lead.

I

Intervention

Unipolar electrosurgical energy (EE) in coagulation mode (fulguration setting, 25 W, 2 seconds each, up to four cycles) applied to the proximal lead pin.

C

Comparator

Electrosurgical energy in cut mode (evaluated in the porcine model only).

O

Outcome

Separation of the lead tip from surrounding tissue and extent of collateral tissue damage/perforation (evaluated macroscopically).safety

Unipolar electrosurgical energy in coagulation mode with a fulguration setting provides a controlled and safe adjunct to manual traction for extracting chronically implanted pacemaker leads.

Limitations

The porcine skeletal muscle model does not fully replicate the intravascular and intracardiac environment where lead fibrosis typically develops.
The tined lead was placed on, rather than implanted into, the muscle mass, limiting the assessment of effects on true fibrotic encapsulation.
Tissue response was evaluated only macroscopically without histopathological analysis.
A single clinical case may not establish reproducibility and safety.
Porcine skeletal muscle model does not fully replicate the intravascular and intracardiac environment or true lead fibrosis.
Acute single time-point study on fresh skeletal muscle tissue.
Experimental protocol used a pushing force rather than a pulling force, and the tined lead was placed on rather than implanted into the muscle mass.
Tissue response was evaluated only macroscopically without histopathological analysis to characterize thermal spread.
Single clinical case does not establish reproducibility and safety; larger clinical studies are necessary.

Implication

Hypothesis-generating for coagulation-mode electrosurgery in lead extraction; leaves open prospective human validation.

Abstract

The increasing use of cardiac implantable electronic devices has led to a rise in transvenous lead extractions (TLEs). The most common indications for TLE are infections and lead malfunction. Over time, leads develop fibrotic encapsulation that makes extraction difficult and increases the risk of myocardial injury. Given the thin myocardial wall, particularly in the right atrial appendage and right ventricular apex, the use of advanced powered tools near the lead tip is contraindicated, posing additional challenges. Electrosurgical energy (EE) has been explored as an adjunct to manual extraction to facilitate safe lead tip removal. This study compares the efficacy and safety of cut and coagulation modes of EE using a porcine tissue model and reports its clinical application in a human case. In the porcine model, the cut mode achieved rapid separation of the lead tip but resulted in deeper tissue penetration. In contrast, the coagulation mode (fulguration setting) enabled controlled dissection with minimal depth of penetration without any collateral injury. The application of the coagulation mode during an actual lead extraction with a dwell time of 8 years in a human patient resulted in complete removal with no postoperative complications. These findings suggest that the coagulation mode of EE offers a safer and more controlled technique for lead tip extraction.

Discussion

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Cite This Study

Reddy et al. (2026) studied Chronically implanted pacemaker/defibrillator lead requiring extraction (porcine model and clinical case) (n=1). Electrosurgical energy in coagulation mode vs. Electrosurgical energy in cut mode (preclinical) / manual traction (clinical) was evaluated on Efficacy of lead separation and safety regarding collateral tissue injury. Electrosurgical energy in coagulation mode enabled safe and controlled lead tip separation without collateral injury in a porcine model, translating to a successful and uncomplicated extraction in a human patient.

synapsesocial.com/papers/6ad0fd063afa093ea9ad0152 https://doi.org/10.19102/icrm.2026.17086

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Electrocautery-assisted Pacemaker Lead Extraction: A Comparative Evaluation of Cutting Versus Coagulation Modes on a Porcine Muscle Model with Clinical Translation.

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Electrocautery-assisted Pacemaker Lead Extraction: A Comparative Evaluation of Cutting Versus Coagulation Modes on a Porcine Muscle Model with Clinical Translation.

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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