Evolution mechanical dilator sheath as a first choice for transvenous lead extraction

Abstract

Objectives: The Evolution mechanical dilator sheath (Cook Medical) uses a rotational mechanism and a bladed tip to overcome fibrosis around cardiovascular implantable electronic devices (CIED) leads. There are only a few reported case series where the Evolution system was used as the first-line choice for CIED lead extraction.The purpose of this study was to report the success of the Evolution system as a first line tool in two centers: the University of California San Francisco Medical Center (San Francisco, CA, USA) and the American University of Beirut Medical Center (Beirut, Lebanon). Method: Between July 2011 and May 2015, the Evolution sheath was used for extraction of pacemaker or implantable cardioverter-defibrillator (ICD) leads in 43 patients (88 leads). Success and complications were defined according to the Heart Rhythm Society expert consensus document on lead extraction. Results: Indications for extraction were infection with or without bacteremia, lead malfunction and subclavian vein stenosis. Evolution was used as first choice in all patients, with 100% clinical success. Complete procedural success was achieved in 38 patients (88.3%); in five patients, the distal electrode with the distal end of the right atrial (RA) or right ventricular (RV) coil was retained. Adverse events were limited to one patient having a consequent pneumothorax and another having a pericardial effusion that did not cause any hemodynamic compromise. Conclusion: Our data suggest that the Evolution mechanical dilator sheath is a useful and safe tool to be used as first line management in transvenous lead extraction. © 2019 American Association for Cancer Research.