Three-Year Experience with a Stylet for Lead Extraction: A Muiticenter Study ECKHARD ALT,^ JORG NEUZNER,^ LUDWIG BINNER,^ KONRAD GOHL,"* JOHAN G.J. RES,'^ ULF-HEINRIGH KNABE,^ MANFRED ZEHENDER,' and JORG REINHARDT" From the ^Klinikum rechts der Isar. Munich, ^Kerckhoff-Klinik, Bad Nauheim, ^Zentrum f. Inn. Med. II d. Universitat. Ulm, ^Kliniktim Nurnberg. Nurnberg. '^'Knappschafts Krankanbaus. Peissenberg. ''Universitatskliniktim, Freiburg, "Institut f. Katbetertecbnik, Weil am Rhein, Germemy; and the '^Akademik Ziegenbuis, Amsterdam, The Netherlands ALT, E., ET AL.: Three-Year Experience with a Stylet for Lead Extraction: A Muiticenter Stndy. Introduc- tion: The extraction of chronically implanted and infected pacemaker and defibriliator leads is an impor- tant issue. This article describes the experience gathered between 1990 and 1994 by seven European centers regarding a locking stylet that is uniformly applicable for a wide variety of internal pacing coil diameters. This interventional locking stylet for lead extraction has an outer diameter of 0.4 mm (0.016 inches). The stylet consists of a hollow shaft in which an inner traction wire is embedded. At the tip of the inner traction wire an anchoring mechanism, which can be opened by retraction, is applied. Removal attempts were made for 150 leads, 110 in ventricular and 40 in atriai positions. Results: Complete removal was possible in 122 cases (81 %). Partial removal was possible in 18 cases (12%). Failure to remove the lead with the extraction stylet was experienced in 10 cases (7%). In seven patients, the leads were removed by cardiothoracic surgery; 3 defective leads were left in place. There were no serious complications associ- ated with the procedure. None of the patients died. Conclusion: The experience with this extraction stylet for lead removal has shown good results. Despite a low complication rate thus far. each case for lead removal should be judged on the individual basis of benefit-to-risk ratio. (PACE 1996; 19:18-25) lead extractions, infections, complications Introduction The extraction of chronically implanted and infected pacemaker and defibrillator leads is an important issue. The challenge thereby is to safely free the lead from the scar tissue encasing the elec- trode at the fixation site. In former years extraction by application of a pulling force was considered state-of-the-art.^"^ The only other option was the surgical removal of the infected leads/"^ This method is highly effective, but risk is associated with the operative procedure. With the advent of the locking stylet, positive results in the technique of transvenous removal have come from many centers implementing Address tor reprints: Eckhard Alt, M.D., 1. Med. KHnik, Klini- kum rechts der Isar der TU, Ismanitiger Str. 22.81675 Miinchen. Germany. Fax: 49-89-4140-4855. Received June 7, 1994; revision December 2, 1994; accepted December 30, 1994. combination of this stylet with other interventional techniques, such as snare-loop catheters/^"^" has greatly improved removal suc- cess rates. The extraction system used in previous reports consisted of a locking stylet that must have a diameter within 0.013 to 0.030 inch to match the lumen of the internal coil. Since the locking procedure is effected by a small additional wire attaching to the tip of the extraction mandrill, an exact size match is mandatory for the success of the locking procedure. This article describes the experience gathered with a locking stylet that is uniformly applicable for a wide variety of internal pacing coil diameters. Methods and Materials Patient Group Transvenous lead removal approaches de- scribed in this article incorporate the experience with 150 leads in 105 patients with implanted 18 January 1996 PACE, Vol. 19