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Multicenter Study
. 2020 Jul 1;22(7):1103-1110.
doi: 10.1093/europace/euaa103.

Results of the Patient-Related Outcomes of Mechanical lead Extraction Techniques (PROMET) study: a multicentre retrospective study on advanced mechanical lead extraction techniques

Christoph T Starck  1   2   3 , Elkin Gonzalez  4 , Omar Al-Razzo  4 , Patrizio Mazzone  5 , Peter-Paul Delnoy  6 , Alexander Breitenstein  7 , Jan Steffel  7 , Jürgen Eulert-Grehn  1   2 , Pia Lanmüller  1 , Francesco Melillo  5 , Alessandra Marzi  5 , Manav Sohal  8 , Giulia Domenichini  8 , Mark M Gallagher  8
Affiliations
Multicenter Study

Results of the Patient-Related Outcomes of Mechanical lead Extraction Techniques (PROMET) study: a multicentre retrospective study on advanced mechanical lead extraction techniques

Christoph T Starck et al. Europace. .

Erratum in

Abstract

Aims: Several large studies have documented the outcome of transvenous lead extraction (TLE), focusing on laser and mechanical methods. To date there has been no large series addressing the results obtained with rotational lead extraction tools. This retrospective multicentre study was designed to investigate the outcomes of mechanical and rotational techniques.

Methods and results: Data were collected on a total of 2205 patients (age 66.0 ± 15.7 years) with 3849 leads targeted for extraction in six European lead extraction centres. The commonest indication was infection (46%). The targeted leads included 2879 pacemaker leads (74.8%), 949 implantable cardioverter-defibrillator leads (24.6%), and 21 leads for which details were unknown; 46.6% of leads were passive fixation leads. The median lead dwell time was 74 months [interquartile range (IQR) 41-112]. Clinical success was obtained in 97.0% of procedures, and complete extraction was achieved for 96.5% of leads. Major complications occurred in 22/2205 procedures (1%), with a peri-operative or procedure-related mortality rate of 4/2205 (0.18%). Minor complications occurred in 3.1% of procedures. A total of 1552 leads (in 992 patients) with a median dwell time of 106 months (IQR 66-145) were extracted using the Evolution rotational TLE tool. In this subgroup, complete success was obtained for 95.2% of leads with a procedural mortality rate of 0.4%.

Conclusion: Patient outcomes in the PROMET study compare favourably with other large TLE trials, underlining the capability of rotational TLE tools and techniques to match laser methods in efficacy and surpass them in safety.

Keywords: Complication; Evolution extraction sheath; Laser lead extraction; Rotational lead extraction; Technical success.

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Figures

Figure 1
Figure 1
Temporal trends in the equipment used in the PROMET cohort. Laser equipment was almost abandoned by all centres within the first half of the experience. There was increasing uptake of rotational dissection sheaths instead of traction-only or laser methods, with a high and constant background usage of locking stylets.
Figure 2
Figure 2
Safety endpoints of the PROMET study in the overall cohort and in the subset in whom rotational dissection sheaths were used.
Figure 3
Figure 3
Complete procedural success in per lead extracted, according to the method used to extract the lead.
See this image and copyright information in PMC

References

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