Evaluation of lead extraction procedures using the Evolution Mechanical Dilator Sheath lead extraction system: a single centre experience

OBJECTIVE
In recent years, there has been an increase in clinical situations requiring extraction of leads of implanted cardiac devices. This study aimed to evaluate the Evolution® Mechanical Dilator Sheath system, presently in use in our clinic for lead extraction procedures.

METHODS
Lead extraction procedures carried out on 20 pa-tients (14 men, 6 women; mean age 61±19; range 23 to 85 years) between 2008 and 2013 using the Evolution system were retrospectively evaluated. Procedural success, and ma¬jor and minor complications were determined according to previously published guidelines.

RESULTS
Mean duration of the lead implantation was 97±65 months (8-204). Fifteen (75%) patients had undergone pace-maker implantation and 5 (25%) had been implanted with a defbrillator. A total of 35 leads were removed from the pa¬tients. Seventeen (49%) were ventricular and 12 (34%) were atrial leads. Five (14%) were defbrillator coils and one of them a coronary sinus lead. Indications for lead extraction were device infection in 18 (90%) and lead dysfunction in 2 (10%) patients. Complete procedural success was 95%. Failure occurred in 1 patient. The major complication rate was 5% and minor complications were seen in 25% of the patients. No case of procedure –related mortality was seen.

CONCLUSION
In this single centre study, it was shown that ex-traction of pacemaker and defbrillator leads of longer postimplantation duration may be successfully carried out using the Evolution system. However, due to potentially serious complications it is advised that extraction be done by an experienced operator in centres with cardiovascular surgery facilities.