Low-temperature electrocautery reduces adverse effects from secondary cardiac implantable electronic device procedures: Insights from the WRAP-IT Trial.

ABSTRACT Background Cardiac device procedures require tissue dissection to free existing device lead(s). Common techniques include blunt dissection, standard electrocautery, or low-temperature electrocautery (PlasmaBladeTM); however, data on the type of electrosurgical tool used and the development of procedure- or lead-related adverse events are limited. Objective Determine whether standard or low-temperature electrocautery impacts the development of an adverse event. Methods We evaluated patients enrolled in the WRAP-IT trial undergoing cardiac implantable electronic device (CIED) revision, upgrade, or replacement. All adverse events were adjudicated by an independent physician committee. Data were analyzed using Cox proportional hazard regression modeling. Results In total, 5641 patients underwent device revision/upgrade/replacement. Electrocautery was used in 5205 (92.3%) patients (mean [±SD] age: 70.6 ± 12.7 years; 28.8% female); low-temperature electrocautery was used in 1866 (35.9%) patients. In comparison to standard electrocautery, low-temperature electrocautery was associated with a 23% reduction in the incidence of a procedure or lead-related adverse event through 3 years of follow up (HR: 0.77, 95% CI: 0.65-0.91; P = 0.002). After controlling for the number of active leads, degree of capsulectomy, and degree of lead dissection, and renal dysfunction, low-temperature electrocautery was associated with a 32% lower risk of lead-related adverse events (HR: 0.68, 95% CI: 0.52 – 0.89, P = 0.004). These effects were consistent across a spectrum of lead-related adverse event types. Conclusion This study represents one of the largest assessments of electrocautery use in patients undergoing CIED revision, upgrade, replacement procedures. Compared to standard electrocautery, low-temperature electrocautery significantly reduces adverse effects from these procedures.