Transvenous lead extraction: Experience of the Tandem approach.

BACKGROUND: Transvenous lead extraction (TLE) is important in the management of cardiac implantable electronic devices but carries risk. TLE is most commonly completed from the superior access, often with 'bail-out' support via the femoral approach. Superior and inferior access may be used in tandem, which has been proposed as an advance in safety and efficacy. AIM: To evaluate the safety and efficacy of the Tandem approach. METHOD: The 'Tandem' procedure entailed grasping of the targeted lead in the right atrium to provide countertraction as a rotational dissecting sheath was advanced over the lead from the subclavian access. Consecutive 'Tandem' procedures performed by a single operator between December 2020 - March 2023 in a single large-volume TLE centre were included and compared with the conventional superior approach (control) using 1:1 propensity score matching; patients were statistically matched for demographics. RESULTS: The Tandem in comparison to the conventional approach extracted leads of much greater dwell time (148.9±79 vs 108.6±77 months, p<0.01) in a shorter procedure duration (96±36 vs 127±67 minutes, p<0.01) but requiring more fluoroscopy (16.4±10.9 vs 10.8±14.9 minutes, p