{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:19:37Z","timestamp":1787008777214,"version":"build-2736575974"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths. This study aimed to compare outcomes with the laser and powered mechanical tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Single-centre data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analysed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analysed. Moreover, we examined the efficacy of each level of the stepwise approach. Out of 166 patients, 142 (age 65.4 \u00b1 13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4 \u00b1 6.3 years). Laser sheaths were used in 64.9%, powered mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (P = 0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in the case of three patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (P = 0.187). Among crossover procedures, only clinical success favoured the secondary mechanical arm (87.1 vs. 54.5%, aOR: 0.09, 95% CI: 0.01\u20130.79, P = 0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The efficacy and safety of laser and mechanical sheaths were similar, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to help improving outcomes, especially in the most complicated cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euac200","type":"journal-article","created":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T17:15:45Z","timestamp":1666372545000},"page":"591-599","source":"Crossref","is-referenced-by-count":17,"title":["A head-to-head comparison of laser vs. powered mechanical sheaths as first choice and second line extraction tools"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6487-3690","authenticated-orcid":false,"given":"Elod-Janos","family":"Zsigmond","sequence":"first","affiliation":[{"name":"Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged , Semmelweis str. 8, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laszlo","family":"Saghy","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged , Semmelweis str. 8, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-8933","authenticated-orcid":false,"given":"Attila","family":"Benak","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged , Semmelweis str. 8, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marton","family":"Miklos","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged , Semmelweis str. 8, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila","family":"Makai","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged , Semmelweis str. 8, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoltan","family":"Hegedus","sequence":"additional","affiliation":[{"name":"Heart Surgery Department, University of Szeged , Semmelweis str. 8, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2969-8484","authenticated-orcid":false,"given":"Endre","family":"Alacs","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, University of Szeged , Semmelweis str. 6, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5007-4647","authenticated-orcid":false,"given":"Szilvia","family":"Agocs","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, University of Szeged , Semmelweis str. 6, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1611-4443","authenticated-orcid":false,"given":"Mate","family":"Vamos","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged , Semmelweis str. 8, 6725 Szeged , Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,11,10]]},"reference":[{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1586\/17434440.2013.811837","article-title":"From lead management to implanted patient management: systematic review and meta-analysis of the last 15 years of experience in lead extraction","volume":"10","author":"Diemberger","year":"2013","journal-title":"Expert Rev Med Devices"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1002\/jbm.10306","article-title":"Morphologic and immunohistochemical observations of tissues surrounding retrieved transvenous pacemaker leads","volume":"63","author":"Esposito","year":"2002","journal-title":"J Biomed Mater Res"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/S0735-1097(99)00074-1","article-title":"Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial","volume":"33","author":"Wilkoff","year":"1999","journal-title":"J Am Coll Cardiol"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.jacc.2009.08.070","article-title":"Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions","volume":"55","author":"Wazni","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1093\/europace\/euaa103","article-title":"Results of the patient-related outcomes of mechanical lead extraction techniques (PROMET) study: a multicentre retrospective study on advanced mechanical lead extraction techniques","volume":"22","author":"Starck","year":"2020","journal-title":"Europace"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.hroo.2021.02.005","article-title":"Performance and outcomes of transvenous rotational lead extraction: results from a prospective, monitored, international clinical study","volume":"2","author":"Sharma","year":"2021","journal-title":"Heart Rhythm O2"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1093\/icvts\/ivy351","article-title":"Efficacy and safety of transvenous lead extraction in 108 consecutive patients: a single-centre experience","volume":"28","author":"Monsefi","year":"2019","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","DOI":"10.1007\/s10840-021-00974-4","article-title":"Reimplantation and long-term mortality after transvenous lead extraction in a high-risk, single-center cohort","author":"Zsigmond","year":"2021","journal-title":"J Interv Card Electrophysiol"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1007\/s00399-020-00728-1","article-title":"Management of cardiac implantable electronic device infection using a complete interdisciplinary approach","volume":"32","author":"Benak","year":"2021","journal-title":"Herzschrittmacherther Elektrophysiol"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1093\/europace\/euy050","article-title":"2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS\/HRS\/LAHRS","volume":"20","author":"Bongiorni","year":"2018","journal-title":"Europace"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/europace\/euz246","article-title":"European heart rhythm association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the heart rhythm society (HRS), the Asia pacific heart rhythm society (APHRS), the latin American heart rhythm society (LAHRS), international society for cardiovascular infectious diseases (ISCVID) and the European society of clinical microbiology and infectious diseases (ESCMID) in collaboration with the European association for cardio-thoracic surgery (EACTS)","volume":"22","author":"Blomstr\u00f6m-Lundqvist","year":"2020","journal-title":"Europace"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"e000177","DOI":"10.1136\/openhrt-2014-000177","article-title":"Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population","volume":"1","author":"Bradshaw","year":"2014","journal-title":"Open Heart"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"2995","DOI":"10.1093\/eurheartj\/ehx080","article-title":"The European lead extraction ConTRolled (ELECTRa) study: a European heart rhythm association (EHRA) registry of transvenous lead extraction outcomes","volume":"38","author":"Bongiorni","year":"2017","journal-title":"Eur Heart J"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1111\/jce.14436","article-title":"Predictors of short-term mortality in patients undergoing a successful uncomplicated extraction 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procedure-related deaths in 1000 consecutive patients: A single-center experience","volume":"17","author":"Stefa\u0144czyk","year":"2021","journal-title":"Vasc Health Risk Manag"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1093\/europace\/euu004","article-title":"Safety and efficacy of internal transjugular approach for transvenous extraction of implantable cardioverter defibrillator leads","volume":"16","author":"Bongiorni","year":"2014","journal-title":"Europace"},{"key":"2023021623524322900_","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.hrthm.2014.12.013","article-title":"Transvenous extraction profile of riata leads: procedural outcomes and technical complexity of mechanical removal","volume":"12","author":"Bongiorni","year":"2015","journal-title":"Heart Rhythm"}],"container-title":["EP 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