Outcomes of transvenous lead extraction using the TightRail™ mechanical rotating dilator sheath and excimer laser sheath

Satish Misra, Kamala Swayampakala, Patricia Coons, Claire Cerbie, Angello Guifarro, Magdalena Lesiczka, John W. Holshouser, Jeko Madjarov, Charles Love, Rohit Mehta

Research output: Contribution to journalArticlepeer-review


Background: Transvenous lead extraction (TLE) is an important part of comprehensive lead management. The selection of tools available has expanded in recent years but data on their efficacy is limited. Objective: To evaluate outcomes using the TightRail™ mechanical rotating mechanical dilator sheath in comparison to excimer laser sheaths and describe factors predictive of successful extraction. Methods: Patients undergoing TLE at a single tertiary center (2013–2019) were included in a prospective registry. Leads targeted for extraction with either an SLS II/Glidelight™ or TightRail™ sheath were included. Outcomes were analyzed on a per-lead basis. Generalized estimating equation (GEE) models were used to assess differences in lead extraction success by extraction tool used while adjusting for nonindependence of multiple leads extracted from the same patient. Covariates included patient comorbidities, lead characteristics, and sheath size. Results: A total of 575 leads extracted from 372 patients were included. Overall success rate was 97%. TightRail™ was the first tool used in 180 (31.3%) leads with success rate of 61.7%; laser sheaths were the first tool in 395 leads (68.7%) with success rate of 67.8%. Predictors of successful extraction included lead age, lead type, and sheath sizing. Extraction success did not differ based on whether a laser or TightRail™ sheath was used (adjusted odds ratio = 0.94; 95% confidence interval = 0.59–1.50). Conclusion: The TightRail™ sheath is an effective tool for TLE. Lead age, lead type, and sheath sizing were predictive of successful extraction but sheath type was not. These findings are hypothesis generating and warrant further investigation in a prospective, randomized study.

Original languageEnglish (US)
Pages (from-to)1969-1978
Number of pages10
JournalJournal of cardiovascular electrophysiology
Issue number7
StatePublished - Jul 2021


  • SLS II
  • TightRail
  • excimer laser sheath
  • glidelight
  • lead extraction
  • lead management
  • mechanical sheath

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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