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. 2025 Dec 8.
doi: 10.1111/jce.70207. Online ahead of print.

Tandem Approach for Transvenous Lead Extraction: Efficacy, Safety, and Operational Learning Curve

Alessio Petrone  1 , Zaki Akhtar  1 , Christos Kontogiannis  1 , Viral Sagar  1 , Jaspal Singh Gill  1 , Lisa W M Leung  1 , Zia Zuberi  1 , Manav Sohal  1 , Mark M Gallagher  1
Affiliations

Tandem Approach for Transvenous Lead Extraction: Efficacy, Safety, and Operational Learning Curve

Alessio Petrone et al. J Cardiovasc Electrophysiol. .

Abstract

Background and aims: The need for transvenous lead extraction (TLE) is rising due to increased cardiovascular device implantation and an aging population. While the superior access is standard, complex cases may benefit from the Tandem approach, combining femoral and superior access to improve efficacy and safety. This study evaluates outcomes and predictors associated with the Tandem approach as a primary strategy.

Methods: A retrospective analysis was conducted on 148 patients who underwent Tandem TLE at a high-volume UK center between September 2020 and December 2024. Data on procedural success, complete lead removal, complications, and outcome predictors were collected. The Needle's eye snare (NES) learning curve was assessed via fluoroscopy time.

Results: Median patient age was 72.4 years, with 42.6% considered high-risk (EROS 3). 319 leads were targeted, with 81.2% extracted via the Tandem approach. Clinical procedural success was 97.3%, and complete lead removal 93%. Use of Medtronic leads was the sole independent predictor of complete lead removal. Major complications occurred in 3.4% of cases, with no procedural mortality. BMI < 25 kg/m² and extraction of ≥ 3 leads were predictors of complications and 30-day mortality. NES proficiency improved significantly after 40 leads (p < 0.001), confirming a learning curve.

Conclusion: The Tandem approach is a safe and effective primary strategy for complex TLE, particularly in cases involving passive fixation, shock, and long dwell times leads. However, widespread use may be limited by resource intensity, increased fluoroscopy exposure, and the need for experienced operators.

Keywords: Needle's eye femoral snare; operational learning curve; predictors of efficacy and safety; tandem approach; transvenous lead extraction.

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References

    1. D. S. Cannom and E. N. Prystowsky, “The Evolution of the Implantable Cardioverter Defibrillator,” Pacing and Clinical Electrophysiology 27 (2004): 419–431, https://doi.org/10.1111/j.1540-8159.2004.00457.x.
    1. F. M. Kusumoto, M. H. Schoenfeld, B. L. Wilkoff, et al., “2017 HRS Expert Consensus Statement on Cardiovascular Implantable Electronic Device Lead Management and Extraction,” Heart Rhythm 14, no. 12 (2017): e503–e551, https://doi.org/10.1016/j.hrthm.2017.09.001.
    1. M. G. Bongiorni, H. Burri, J. C. Deharo, et al., “2018 EHRA Expert Consensus Statement on Lead Extraction: Recommendations on Definitions, Endpoints, Research Trial Design, and Data Collection Requirements for Clinical Scientific Studies and Registries: Endorsed by APHRS/HRS/LAHRS,” EP Europace 20, no. 7 (2018): 1217, https://doi.org/10.1093/europace/euy050.
    1. J. Keiler, M. Schulze, M. Sombetzki, et al., “Neointimal Fibrotic Lead Encapsulation–Clinical Challenges and Demands for Implantable Cardiac Electronic Devices,” Journal of Cardiology 70, no. 1 (2017): 7–17, https://doi.org/10.1016/j.jjcc.2017.01.011.
    1. B. L. Wilkoff, C. L. Byrd, C. J. Love, et al., “Pacemaker Lead Extraction With the Laser Sheath: Results of the Pacing Lead Extraction With the Excimer Sheath (PLEXES) Trial11No Financial Support Was Received for Performing the Procedures or Collecting the Data, or for Data Analysis,” Journal of the American College of Cardiology 33, no. 6 (1999): 1671–1676, https://doi.org/10.1016/s0735-1097(99)00074-1.

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