Outcomes of Transvenous Lead Extraction of Very Old Leads Using Bidirectional Rotational Mechanical Sheaths: Results of a Multicentre Study.

the main indication for TLE was infection in 74% of cases.Complete procedural success rate, clinical success rate, per lead were 94.8 and 98% respectively.Failure of lead extraction was seen in 1.8% of leads.The additional use of a snare via the femoral approach was required in 9% of patients.Lead dwell time was the only predictor of incomplete led removal (OR 1.009,95%CI 1.003-1.014,P=0.002).Four major complication (2%) were encountered.During a mean time follow-up of 31±27 months, 21 patients (11%) died.No procedure-related mortality occurred.Predictors of mortality included severe systolic dysfunction (HR 8.06;95%CI 2.99-21.73;P=0.001), TLE for infection (HR 8.0;95%CI 1.04-62.5;P=0.045), diabetes (HR 3.7;95%CI 1.48-9.5;P=0.005), and previous systemic infection (HR 3.1;95%CI 1.17-8.24;P=0.022).Incomplete lead removal or failure lead extraction did not impact on survival during follow-up CONCLUSION: our findings demonstrated that the use of bidirectional rotational TLE mechanical sheaths combined with different mechanical tools and femoral approach allows reasonable success and safety in patients with very old leads at experienced specialised centres. This article is protected by copyright. All rights reserved.