Background: Transvenous lead extraction may become a complicated process and special sheath systems used for extraction may not be
available in the laboratory. Transvenous lead extraction from femoral vein by using ablation catheter and snare may be an alternative and
cost-effective method to transvenous lead extraction with specialized lead extraction sheaths. The aim of the present study is to evaluate the
factors that may be associated with the use of transfemoral technique during extraction of chronically implanted leads.
Methods: We retrospectively analyzed consecutive patients who underwent transvenous extraction of pacemaker, cardiac resynchronization
therapy (CRT) and intracardiac defibrillator (ICD) leads in our institution in between 01.01.2016 and 01.01.2019. The indications for lead extraction
were based on the European Heart Rhythm Association recommendations. Manual traction was applied to all leads at the beginning
of each case. If manual traction was not successful, a subclavian approach by using locking stylet (Liberator Universal Locking Stylet, Cook
Medical) or femoral approach was used. Femoral approach was performed using the flexible 13F long sheath and a second sheath for ablation
catheter. Ablation catheter was wrapped around the lead and the tip of the ablation catheter was caught with gooseneck snare. Downward
traction was applied on the body of the lead by using ablation catheter and gooseneck snare complex to release either end of the lead.
Results: A total of 160 leads in 94 patients were extracted during the time interval between 01.01.2016 and 01.01.2019. The indications for
extraction were cardiac device related pocket erosion and infection in 71 (75.6%) and lead failure in the 23 (24.4%) cases. Extracted system
was ICD in 48 (51.1%), CRT in 9 (9.6%) and pacemaker in 37 (39.3%) cases. The median time from the preceding procedure was 62.5
(IQR:32.3- 95.3) months. Lead extraction was performed by manual traction in 35 (37.2%) patients, by locking stylet method in 7 (7.4%) and
by femoral approach in 52 (55.3%) patients. Clinical success was achieved in 93 (98.9%) cases and all of the patients discharged uneventfully
without a major complication as death, cardiac avulsion or tear requiring pericardiocentesis or emergent surgery. Procedural success
with femoral approach was achieved in 51/52 (98%) patients (99 leads). Ordinal regression revealed the time from the preceding procedure
as the only parameter that was significantly associated with the usage of femoral approach (OR:1.065 ( 95% CI 1.039-1.100) p < 0.001).
Conclusion: Based on our experience, transfemoral approach by using ablation catheter and gooseneck snare seems to be an effective and
safe method for chronically implanted lead extraction. It may be particularly be useful when manual traction is unsuccessful and special toolkids
are not available for extraction.