AI Article Synopsis
- The study observed 112 patients undergoing transvenous lead extraction (TLE) to evaluate factors associated with the need to switch from a GlideLight laser sheath to the Evolution system during the procedure.
- Approximately 50.9% of patients required this crossover, yet both groups demonstrated similar high clinical success rates (around 98.3% to 100%) with no major complications recorded.
- Key factors influencing the need for crossover included the age of the oldest lead, the number of leads extracted, and the approach used, with a significant cutoff point of 7.7 years for lead dwell time.
Article Abstract
Background: During transvenous lead extraction (TLE), a GlideLight laser sheath (Philips) cannot always be advanced over the lead, and crossover to the Evolution system (i.e., an Evolution RL sheath or Evolution Shortie RL sheath [Cook Medical]) is required. We aimed to determine the associated factors and outcomes of such device crossover.
Methods: This observational study included 112 patients who underwent TLE. The patients were divided into crossover and non-crossover groups. Outcomes and associated factors of crossover were evaluated.
Results: Overall, 57 (50.9%) patients required crossover to the Evolution system (crossover group), whereas 55 (49.1%) patients did not require crossover (non-crossover group). Clinical success rate was similar between the two groups (98.3% vs. 100%; = 1.00). No major intraprocedural complications related to powered sheaths occurred. Multivariate logistic regression analysis results showed that dwell time of the oldest extracted lead (per year) (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 1.02-1.36; = .026), number of leads extracted per procedure (OR: 7.23, 95% CI: 1.74-29.99; = .007), and use of a femoral approach (OR: 21.09, 95% CI: 2.33-190.67; = .007) were associated factors of crossover. The cutoff for crossover was 7.7 years from the implant (sensitivity 90.5%, specificity 64.9%, area under the curve 0.80).
Conclusions: Both groups showed a high rate of clinical success. Switching to the Evolution system may facilitate a safe and effective TLE when a laser sheath does not advance despite laser activation.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692839 | PMC |
| http://dx.doi.org/10.1002/joa3.12929 | DOI Listing |
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