Multicentric experience with the use of short 13Fr bidirectional mechanical rotating dilator sheath for transvenous lead extraction

Abstract 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.