Background: The growing problem of endocardial lead infection and lead malfunction has increased the interest in transvenous lead extraction technology. There are limited data on the comparative analyses of TightRail rotating dilator sheath (Philips) and laser sheath for lead extraction.
Objective: To compare the procedural outcomes of transvenous lead extraction with TightRail sheath and laser sheath.
Methods: Retrospective cohort analysis of consecutive patients who underwent transvenous lead extraction using either TightRail sheath and/or GlideLight laser sheath (Philips) in our hospital between January 2015 and October 2019.
Results: During this period, 349 leads in 185 patients were extracted, including 29 leads extracted by TightRail sheath alone, 38 by TightRail sheath after unsuccessful attempt of laser extraction, and 277 by laser sheath alone. The percentage of using Tightrail sheath gradually increased from 5.0% in 2015 to 46.9% in 2019. Indications for lead extraction included device-related infection in 83 (44.9%) patients, lead malfunction or lead-related complications in 85 (45.9%) patients, and device upgrade in 17 (9.2%) patients. Among 349 leads, 190 were pacing leads, 42 were single-coil implantable-cardioverter defibrillator (ICD) leads, 80 were dual-coil ICD leads, and 35 were coronary sinus leads. The median age of leads was 8 years (1-28 years). The success rates of complete extraction by TightRail sheath alone and laser sheath alone were similar (89.7% versus 86.0%, P= 0.58). For leads>10 years old, the success rate with TightRail alone was 93.8% versus 73.4% with laser alone (P=0.07). Among 38 leads extracted by TightRail sheath after an unsuccessful attempt by laser sheath, 25 (65.8%) had complete success, 4 (10.5%) had partial success with lead remnant less than 4 centimeters. Acute complication rate (overall 5.9%) and procedure mortality (overall 0%) were similar between TightRail and laser extraction.
Conclusion: Our experience confirms that the mechanical technique with TightRail system is an effective first-line and second-line method for lead extraction. Further investigation is required to provide guidance for the selection of mechanical and laser sheaths in lead extraction cases.