Transvenous lead extraction: Experience of the Tandem approach

• DOI: 10.1093/europace/euad331
• Publication Date: 2023-11-08T06:34:24Z
• Authors: Zaki Akhtar; Christos Kontogia...; Ahmed I Elbatran; Lisa W M Leung; Christoph T Starck; Zia Zuberi; Manav Sohal; Mark M Gallagher
• Keywords: Composite material; Pacemaker, Artificial; Time Factors; Cardiac Resynchronization Therapy in Heart Failure; Cardiology; Clinical psychology; Catheter Ablation of Cardiac Arrhythmias; Tandem; Sociology; Propensity score matching; Health Sciences; Practical EP; Humans; Internal medicine; Device Removal; Retrospective Studies; Demography; Geology; Geomorphology; FOS: Earth and related environmental sciences; Molecular Mechanisms of Cardiac Arrhythmias; Dwell time; Lead (geology); Materials science; 3. Good health; Defibrillators, Implantable; FOS: Sociology; Treatment Outcome; Fluoroscopy; Catheter Ablation; Medicine; Surgery; Demographics; Cardiology and Cardiovascular Medicine

Abstract

Aims Transvenous lead extraction (TLE) is important in the management of cardiac implantable electronic devices but carries risk. It is most commonly completed from the superior access, often with ‘bail-out’ support via the femoral approach. Superior and inferior access may be used in tandem, which has been proposed as an advance in safety and efficacy. The aim of this study is to evaluate the safety and efficacy of the Tandem approach.

Method The ‘Tandem’ procedure entailed grasping of the targeted lead in the right atrium to provide countertraction as a rotational dissecting sheath was advanced over the lead from the subclavian access. Consecutive ‘Tandem’ procedures performed by a single operator between December 2020 and March 2023 in a single large-volume TLE centre were included and compared with the conventional superior approach (control) using 1:1 propensity score matching; patients were statistically matched for demographics.

Results The Tandem in comparison with the conventional approach extracted leads of much greater dwell time (148.9 ± 79 vs. 108.6 ± 77 months, P < 0.01) in a shorter procedure duration (96 ± 36 vs. 127 ± 67 min, P < 0.01) but requiring more fluoroscopy (16.4 ± 10.9 vs. 10.8 ± 14.9 min, P < 0.01). The Tandem and control groups had similar clinical (100% vs. 94.7%, P = 0.07) and complete (94.8% vs. 92.8%, P = 0.42) success, with comparable minor (4% vs. 6.7%, P = 0.72) and major (0% vs. 4%, P = 0.25) complications; procedural (0% vs. 1.3%, P = 1) and 30-day (1.3% vs. 4%, P = 0.62) mortality were also similar.

Conclusion The Tandem procedure is as safe and effective as the conventional TLE. It can be applied to leads of a long dwell time with a potentially shorter procedure duration.