Upfront tandem versus superior-first approaches for transvenous lead extraction: a propensity score overlap weighting analysis

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Background Although the superior-first approach is the standard strategy for transvenous lead extraction (TLE), the upfront tandem approach, combining femoral snaring with the superior approach from the outset, may offer procedural advantages. Objectives This study compared outcomes between the two approaches after adjustment for confounding factors related to extraction difficulty. Methods We retrospectively analyzed consecutive TLE patients at a single center in Japan between September 2014 and March 2026. Overlap weighting based on propensity scores was applied to balance prespecified baseline characteristics. Outcomes included complete procedural success, cardiac or vascular injury, procedure-related mortality, and blood transfusion. Results Overall, 318 patients were included (82 upfront tandem, 236 superior-first). Patients in the upfront tandem group were younger, had a longer dwell time of the oldest lead, and had a higher prevalence of implantable cardioverter defibrillator leads than those in the superior-first group. After overlap weighting, no significant differences were observed in complete procedural success (94.8% vs 91.5%; odds ratio [OR] 1.70, 95% confidence interval [CI] 0.51–5.71) or cardiac or vascular injury (2.1% vs 1.6%; OR 1.34, 95% CI 0.14–12.50), with no procedure-related deaths in either group. Blood transfusion was significantly less frequent in the upfront tandem group (4.5% vs 16.7%; OR 0.24, 95% CI 0.07–0.83). Conclusions After adjustment for confounding by indication, no significant differences were observed in complete procedural success or cardiac or vascular injury between the two approaches. The upfront tandem approach was associated with less blood transfusion and may be a reasonable alternative in selected patients.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.