Sequential use of different mechanical rotational tools greatly improves success of lead extraction

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Both Evolution RL and Tightrail mechanical rotational tools (MRT) have shown good success rates with low complication rates for lead extraction. PURPOSE: To demonstrate the incremental value of switching between the two MRT devices to improve outcome. METHODS: We performed a retrospective single centre study of consecutive lead extractions from the time when both devices were available, and in whom at least one MRT device was used as primary extraction tool. If the initial MRT device did not show any progress after a prolonged attempt, we switched to the other tool. If still unsuccessful, or leads became unsuitable for MRT extraction, a femoral back up with the Needle’s Eye snare was attempted. We consider the outcome on a per lead basis. RESULTS: From 1/2015 till 9/2022, at least one MRT device was the primary extraction tool in 162 pts (median age 71.7 [64.1 - 78.5], 28.4% female, 49.9% ICD patients, indication infection 95.7%). MRT was used in 243 of 405 leads implanted for more than 1 year. A Tightrail was used as back up in 15 leads (9.7%) of 155 Evolution attempts, augmenting clinical successful outcome from 81.3% to 91.0%. An Evolution served as back up in 10 leads (11.4%) of 88 Tightrail procedures, increasing clinical successful outcome from 77.3% to 88.6%. After femoral bail out the clinical successful outcome increased respectively to 98.1% and 98.9% for Evolution RL and Tightrail primary attempts. Major complications occurred in 2 pts with the Evolution RL (one intrapericardial tear; the second a late tamponade possibly from a perforated temporary pacing lead), in none with the Tightrail. There were no complications after switching tools. CONCLUSION: Switching between MRT devices can be very effective in case of stalled progress during lead extraction. [Figure: see text]