Incidence and predictors of successful lead extraction with short active mechanical extraction sheaths only

Abstract Background and aims Transvenous lead extraction (TLE) is increasingly performed for malfunction or infection of cardiac implantable electronic devices. Active mechanical rotational sheaths facilitate extraction and are available in short and long sizes. This study aimed to evaluate the incidence and predictors of successful TLE using only short active mechanical sheaths. Methods We retrospectively analysed patients who underwent TLE at a single centre from 2013 until 2023 regarding clinical and radiological success and complications. Results 556 patients underwent 568 TLE from January 2013 until December 2023. 55 (9.7%) TLE were successful using only short mechanical sheaths. Predictors for successful TLE using only short sheaths in multivariate analysis were lead dwell time (OR 0.98, CI 0.97 – 0.99, p < 0.001) and anticoagulation (OR 0.60, CI 0.34 – 1.08, p < 0.05). Major complications occurred in 4.8% of TLE with a numerically lower rate when only short sheaths were used (3.6%). Conclusion Short active rotational mechanical sheaths are sufficient for successful TLE in 10% of patients. Anticoagulation and lead dwell time are independent predictors of successful TLE with short active extraction sheaths only.Baseline characteristics Predictors of successful extraction