A Novel Technique to Extract Implanted Leads Using Simple Stylets and Reused Rotational Sheaths in Patients with a Cardiac Implantable Electronic Device

OBJECTIVE
Transvenous lead extraction (TLE) is used in various clinical scenarios such as device related infections. Mechanical powered sheaths are one of the mainly used tools for TLE procedures. We evaluated the procedural and clinical outcomes of the novel extraction technique of the chronically implanted leads in the treatment of device related infections.

METHODS
The novel extraction technique utilizing standard implantation stylets, snares, reused rotational sheaths, catheters, and wires was evaluated for procedural success and clinical outcomes.

RESULTS
A total of 12 consecutive patients with device related infection underwent the novel TLE procedure. Complete procedural success was obtained in all patients with a minor complication rate of 8% (1 patient). No major complication or procedure related mortality was observed. During a median follow-up period of 435 days, one mortality occurred due to multi-drug-resistant systemic infection, one due to end-stage heart failure, and one patient underwent valve surgery due to additional valve endocarditis. There were no cases of reinfection in the study population. In addition, this novel technique was found to be approximately 85% cheaper than the conventional standard technique including locking stylets and unused rotational sheaths.

CONCLUSION
In cases where it is not possible to procure unused extraction tools or due to reimbursement issues, the novel TLE technique can provide an effective and safe solution.