The no-cut technique for lead preparation in transvenous lead extraction: a preliminary single centre experience

Lead fragmentation is a common issue during transvenous lead extraction (TLE), often hindering complete procedural success despite extended procedure time and the use of specific recapturing tools. Retaining the catheter connector pin has proven to increase the lead tensile strength at bench testing, potentially reducing the risk of fragmentation. However, standard lead preparation for TLE requires removing the connector pin to allow placement of a lead-locking device (LLD) directly into the inner lumen of the catheter. This study aims to investigate the real-world feasibility of systematic connector retention (no-cut technique, NCT) during TLE using mechanically powered sheaths.

Consecutive patients undergoing IS1 and DF4 leads extraction for any indication were enrolled. For NCT both leads types were prepared using a standard LLD placed directly into the connector pin (Figure1). After a first attempt of simple traction, a 13F short bidirectional mechanical extractor (Spectranetics SubC) was systematically used by passing over the retained connector. Silicone insulation on DF4 leads was manually trimmed only in cases of excessive friction while IS1 leads were left intact. If needed, an additional 13F long mechanical sheath (Cook Evolut RL 13F or Spectranetics TightRail 13F) was used to complete lead extraction. Femoral and jugular snares were used as bailout only in case of lead fragmentation. Procedural data and radiological success rates were compared with an historical cohort performed by the same experienced operators according to the standard technique.

From June 2023 to June 2024 a total of 165 leads were extracted in 76 patients (78 % males, age 61± 17 years). Main indication for TLE was infection (n= 50, 66%) followed by lead malfunction (n=20, 25%). In total, 65 leads (20 ICD, 35 atrial, 10 RV pacing) were extracted with the new NCT while 100 leads (42 ICD, 30 atrial, 28 RV pacing) were used as control. No major complication was observed in both groups. Mean lead dwelling time was comparable (12±5ys for NCT vs 14±7.3ys for control p=0.32) as well as procedure duration (112±15 min for NCT vs 120±9 min for control p=0.20) and total fluoroscopy time (917±220sec for NCT vs 945±481sec for control p=0.45). Despite no extraction failure was observed in both groups, the NCT group had a lower rate of incomplete radiological success (retained lead tip or lead fragment) compared to standard technique (n=1, 1.53% for NCT versus n=9, 9% for control p=0.04).

NCT is a safe and feasible option during TLE accounting for a lower risk of lead fragmentation and incomplete radiological success.

Standard (left lead) vs NCT (right lead)