Advanced techniques for chronic lead extraction: Heading from the laser towards the evolution system

Patrizio Mazzone, Dimitris Tsiachris, Alessandra Marzi, Giuseppe Ciconte, Gabriele Paglino, Nicoleta Sora, Simone Gulletta, Pasquale Vergara, Paolo Della Bella

Research output: Contribution to journalArticle


AimThe evolution mechanical dilator sheath has been reported to be an effective tool for chronic lead extraction (LE). We examined safety and efficacy of evolution system as compared with laser system.Methods and resultsFrom 2005 to 2009, all extractions requiring the use of a powered sheath were performed using the excimer laser system (n = 73). Since 2009, laser system was no longer available and the evolution system was introduced as the first-line method for powered extraction (n = 48). All procedures were performed by a single first operator. Success and complications were defined according to the current guidelines. Patients of the evolution group compared with those of the laser group had a greater number of extracted leads per patient (2.77 vs. 2.4, P = 0.049) and a longer implant duration (101.1 vs. 62.4 months, P = 0.001). Additional use of snare was required in 27.1% of the evolution group and 8.2% of the laser group (P = 0.005). Complete procedural success was achieved in 91.7% of the evolution group and 97.3% of the laser group (P = 0.16). There was also no difference between evolution and laser groups in clinical success (97.9 vs. 98.6%, P = 0.76), as well as regarding major (4.2 vs. 2.7%, P = 0.66) or minor complications (4.2 vs. 5.5%, P = 0.76).ConclusionUse of the recently introduced evolution system for LE exhibit acceptably high levels of safety, as well as of procedural and clinical success, although additional use of snare was required more frequently in the evolution compared with the laser group.

Original languageEnglish
Pages (from-to)1771-1776
Number of pages6
Issue number12
Publication statusPublished - Dec 2013


  • Lead extraction
  • Powered sheath
  • Snare

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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