Document Detail

Initial experience with the Evolution mechanical dilator sheath for lead extraction: safety and efficacy.
MedLine Citation:
PMID:  20346418     Owner:  NLM     Status:  MEDLINE    
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.
Ayman A Hussein; Bruce L Wilkoff; David O Martin; Saima Karim; Mohamed Kanj; Thomas Callahan; Bryan Baranowski; Walid I Saliba; Oussama M Wazni
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Publication Detail:
Type:  Journal Article     Date:  2010-03-23
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  7     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-15     Completed Date:  2010-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  870-3     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Cleveland Clinic, Cleveland, Ohio, USA.
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MeSH Terms
Defibrillators, Implantable*
Device Removal / instrumentation*
Electrodes, Implanted*
Equipment Design
Pacemaker, Artificial*
Prosthesis-Related Infections / surgery
Comment In:
Heart Rhythm. 2010 Jul;7(7):874-5   [PMID:  20434590 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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