Transvenous lead extraction in children with bidirectional rotational dissection sheaths.

Objectives: Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and the use of powered mechanical dissection sheaths is limited.
Methods: We performed a retrospective cohort study analyzing all children <18 years that underwent TLE in our institution from 2015 to 2022. Procedural complexity, results and complications were defined as recommended by recent consensus statements.
Results: Twenty-eight children [median age 12.8 (interquartile range 11.3-14.6) years] were included. Forty-one leads were extracted [median dwell time 85 (interquartile range 52-102) months]. Extractions of 31 leads (76%) in 22 patients (79%) were complex, requiring advanced extraction tools including powered bidirectional rotational dissection sheaths in 14 children. There were no major complications. Complete procedural success was achieved in 18 (64%) and clinical success in 27 patients (96%), respectively. Procedural success and complexity varied between lead types. The Medtronic SelectSecure™ lead was associated with increased odds of extraction by simple traction ( p  = 0.006) and complete procedural success ( p  < 0.001) while the Boston Scientific Fineline™ II lead family had increased odds of partial procedural failure ( p  = 0.017).
Conclusions: TLE with the use of mechanical powered rotational dissection sheaths is feasible and safe in pediatric patients. In light of rare complications and excellent overall clinical success, TLE should be considered an important cornerstone in lifetime lead management in children. Particular lead types might be more challenging and less successful to extract.
Competing Interests: VF, CS and FB declare relevant financial activities unrelated to the submitted work with several commercial entities. VF has relevant financial activities with Medtronic, Biotronik, Abbott, Boston Scientific, Edwards Lifesciences, Berlin Heart, Novartis Pharma, JOTEC and Zurich Heart in relation to educational grants (including travel support), fees for lectures and speeches, fees for professional consultation and research and study funds. CS has received consulting fees and travel expenses from Medtronic; consulting fees and research support from Biotronik; research support from Abbott; workshop fees, consulting fees, educational grants, and research support from Cook Medical; consulting fees from Spectranetics/Philips; consulting fees from Angiodynamics. FB has received consulting fees and travel expenses from Medtronic; consulting fees, travel expenses and research support from Abbott; consulting fees from Venus Medtech Europe. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(© 2023 Heck, Peters, Lanmüller, Photiadis, Berger, Falk, Starck and Kramer.)