BACKGROUND: The Evolution mechanical dilator sheath is a new lead extraction tool that uses a rotational mechanism and a bladed tip to overcome fibrosis. OBJECTIVE: The purpose of this study was to report our initial experience with the Evolution system. METHODS: Between March 2008 (our first use of Evolution) and September 2009, the Evolution sheath was used for extraction of pacemaker or implantable cardioverter-defibrillator (ICD) leads in 29 patients (41 leads). Success and complications were defined according to the Heart Rhythm Society expert consensus document on lead extraction. RESULTS: Indications for extraction were infection in 20 patients and lead malfunction in 9 patients. Median implantation time was 65 months (range 12-409 months). Of the 41 leads, 18 (44%) were atrial and 23 (56%) were ventricular. ICD leads were extracted from 14 (48%) patients and pacemaker leads from 15 (52%) patients. Evolution was used as first choice in 12 patients (16 [39%] leads), with 100% clinical success. Complete procedural success was achieved in 11 patients; in 1 patient, only the distal electrode was retained. The system was used for "rescue" of 25 (61%) leads in 17 patients. Success with Evolution alone was achieved in 13 (77%) patients (Shortie Evolution sheath used in 2), for complete procedural success of 77%. However, in 4 (24%) patients, Evolution was useful but not sufficient for complete procedural success (femoral workstation required in 2, reuse of laser in 2). Overall, the Evolution system was successful in 25 (86%) patients (33 leads). Overall clinical success was 100%. No complications occurred. CONCLUSION: Preliminary data suggest that the Evolution mechanical dilator sheath is a new useful tool among the instruments available for lead extraction. Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
BACKGROUND: The Evolution mechanical dilator sheath is a new lead extraction tool that uses a rotational mechanism and a bladed tip to overcome fibrosis. OBJECTIVE: The purpose of this study was to report our initial experience with the Evolution system. METHODS: Between March 2008 (our first use of Evolution) and September 2009, the Evolution sheath was used for extraction of pacemaker or implantable cardioverter-defibrillator (ICD) leads in 29 patients (41 leads). Success and complications were defined according to the Heart Rhythm Society expert consensus document on lead extraction. RESULTS: Indications for extraction were infection in 20 patients and lead malfunction in 9 patients. Median implantation time was 65 months (range 12-409 months). Of the 41 leads, 18 (44%) were atrial and 23 (56%) were ventricular. ICD leads were extracted from 14 (48%) patients and pacemaker leads from 15 (52%) patients. Evolution was used as first choice in 12 patients (16 [39%] leads), with 100% clinical success. Complete procedural success was achieved in 11 patients; in 1 patient, only the distal electrode was retained. The system was used for "rescue" of 25 (61%) leads in 17 patients. Success with Evolution alone was achieved in 13 (77%) patients (Shortie Evolution sheath used in 2), for complete procedural success of 77%. However, in 4 (24%) patients, Evolution was useful but not sufficient for complete procedural success (femoral workstation required in 2, reuse of laser in 2). Overall, the Evolution system was successful in 25 (86%) patients (33 leads). Overall clinical success was 100%. No complications occurred. CONCLUSION: Preliminary data suggest that the Evolution mechanical dilator sheath is a new useful tool among the instruments available for lead extraction. Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Authors: Christoph T Starck; Elkin Gonzalez; Omar Al-Razzo; Patrizio Mazzone; Peter-Paul Delnoy; Alexander Breitenstein; Jan Steffel; Jürgen Eulert-Grehn; Pia Lanmüller; Francesco Melillo; Alessandra Marzi; Manav Sohal; Giulia Domenichini; Mark M Gallagher Journal: Europace Date: 2020-07-01 Impact factor: 5.214
Authors: Saumya Sharma; Byron K Lee; Anuj Garg; Robert Peyton; Brian T Schuler; Pamela Mason; Peter Paul Delnoy; Mark M Gallagher; Ramesh Hariharan; Raymond Schaerf; Ruirui Du; Nina D Serratore; Christoph T Starck Journal: Heart Rhythm O2 Date: 2021-03-02