176-62: Usefulness of TightRail™ Rotating Mechanical Dilator Sheath for Transvenous Lead Extraction: Safety and Efficacy Outcomes

Abstract

Purpose: In parallel with increasing implantation rates and patients' longer life expectancy, the need for transvenous lead extraction (TLE) as a specialized procedure has shown a significant growth over years. Herein, we aimed to present our initial experience in TLE by using a novel TightRail™ Rotating Mechanical Dilator Sheath. Methods: Between October 2014 and September 2015, a total of 64 leads in 35 patients were removed at our tertiary referral centre. All of the extracted leads were >12 months old and indications for extraction were based on the recommendations of the Heart Rhythm Society. The leads were removed by using the TightRail™ Mechanical Dilator Sheath (Spectranetics Corporation) with the rotational cutting force only. Results: Indications for lead removal included cardiac device infection in 22 (62.9%) cases, lead malfunction in the 12 (34.3%) cases and upgrade to CRT-D in the remaining 1 case (2.8%). The extracted devices were pacemaker in 12 (34.3%) cases, ICD in 13 (37.1%) cases and CRT in the remaining 10 (28.6%) subjects. Mean number of extracted leads per patient was 1.86 ± 0.77. Among 64 leads, 12 (18.8%) were right ventricular, 23 (35.9%) were atrial, 22 (34.3%) were defibrilator and 7 (10.9%) were coronary sinus electrodes. The median time from implantation was 60 (12–216) months. Complete procedural success with TightRail™ system alone was achieved in 33 (94.3%) patients (62/64 leads) and overall clinical success was 100%. One right ventricular and another right atrial leads were completely removed with the help of snaring. All the patients were discharged uneventfully without any complication. Conclusions: Our small sized study results showed that TightRail™ mechanical dilator sheath is a novel useful tool for chronically implanted PM/ICD leads. Continued investigation including large patient cohort is required to evaluate success and complication rates in comparison to other tools and techniques.