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. Mechanically powered sheaths are one of the most commonly used tools for TLE procedures. We evaluated the procedural and clinical outcomes of a novel extraction technique for chronically implanted leads in the treatment of device-related infections.

Method: 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 infections underwent the novel TLE procedure. Complete procedural success was achieved in all patients, with a minor complication rate of 8% (one patient). No major complications or procedure-related mortality were observed. During a median follow-up period of 435 days, one patient died due to a multidrug-resistant systemic infection, one due to end-stage heart failure, and one underwent valve surgery for concomitant valve endocarditis. No cases of reinfection were reported in the study population. Additionally, this novel technique was approximately 85% less costly than the conventional standard technique using locking stylets and unused rotational sheaths.

Conclusion: In situations where unused extraction tools are unavailable or limited by reimbursement constraints, this novel TLE technique offers an effective and safe alternative.

Keywords: Extraction, infection, reused, stylets