Key result
Short 13 Fr rotational mechanical sheath yields ~97% clinical success during transvenous lead extraction.
Why the study?
The need for transvenous lead extraction is increasing worldwide and the course from the subclavian vein to the superior vena cava junction is a frequent site of lead adherences, prompting evaluation of the safety and efficacy of a short bidirectional rotational mechanical sheath in high-volume centres.
Does a short 13 Fr bidirectional rotational mechanical sheath provide safe and effective transvenous lead extraction in patients with cardiac implantable electronic devices?
Observational (n=202)
Yes
Does a short 13 Fr bidirectional rotational mechanical sheath provide safe and effective transvenous lead extraction in patients with cardiac implantable electronic devices?
Routine initial use of a short 13 Fr bidirectional rotational mechanical sheath in a stepwise transvenous lead extraction approach is safe and achieves complete extraction without needing a longer sheath in two-thirds of patients at high-volume centers.
Answers are grounded in this paper and cite their sources.
May support short sheath-first TLE in high-volume centers; leaves open randomized confirmation of safety and efficacy.
Background The need for transvenous lead extraction (TLE) is increasing worldwide and the course of the subclavian vein until the junction with the superior vena cava is a frequent place of lead adherences. Here we aim to assess the safety and efficacy of a short bidirectional rotational mechanical sheath in high volume centres. Methods and results in this multicentric study, 202 carriers of a cardiac implantable electronic device (CIED) undergoing TLE using a short 13 Fr bidirectional rotational mechanical sheath were prospectively enrolled. All procedures were performed by using the stepwise approach. The indication for TLE were infection (62%), malfunction (32%) and upgrade (6%). Overall, 471 leads were extracted: 65% pacing leads, 20% defibrillator leads, 9% left ventricle leads and 6% abandoned leads. Clinical success and lead complete extraction have been achieved in 97% and 95% of cases, respectively. The short sheath was always effective in gaining venous access at the start of the procedure and was sufficient for complete TLE in 67% of cases. Lead dwell time, defibrillator lead, number of leads per patient and lead malfunction were predicting factors of long bidirectional rotational mechanical sheath use. There were no cases of intraprocedural death and major complications were reported in 2% of patients. Overall survival was 97% at 1-year follow up. Conclusion This multicentric experience using a short bidirectional rotational mechanical sheath reported a high safety and efficacy profile for TLE when performed in high volume centres, proving the utility of routine use of short extraction sheaths.
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Preda et al. (2025) conducted an observational in Cardiac implantable electronic device (CIED) carriers requiring transvenous lead extraction (n=202). Short 13 Fr bidirectional rotational mechanical dilator sheath was evaluated on Clinical success and complete lead extraction. A short 13 Fr bidirectional rotational mechanical sheath achieved 97% clinical success, 95% complete lead extraction, and 2% major complications during transvenous lead extraction.
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