A head-to-head comparison of the first choice and crossover lead extraction tool: laser vs. mechanical

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths. Purpose This study aimed to compare outcomes with the laser and mechanical tools. Methods Single-center data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analyzed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analyzed. Moreover, we examined the efficacy of each level of the stepwise approach. Results Out of 166 patients 142 (age 65.4±13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4±6.3 years). Laser sheaths were used in 64.9%, mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (p=0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in case of 3 patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (p=0.187). Among crossover procedures only clinical success favored the secondary mechanical arm (87.1% vs. 54.5%, aOR: 0.09, 95%CI: 0.01-0.79, p=0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery (Figure). Conclusion The efficacy and safety of laser and mechanical sheaths were similar in our study, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to be indispensable in order to achieve the most optimal outcomes.