Electrosurgical Sheaths

Reports in the literature suggest that powered sheaths are more effective than mechanical sheaths [10] in some experiences, their use is associated with a higher incidence of major complications and is undoubtedly more expensive. In the near future, the cost/benefit ratio of both techniques will require careful evaluation probably, most procedures could be performed by mechanical techniques, whereas powered sheath techniques should be reserved for select cases. 

---

Electrosurgical sheaths sheaths that use radiofrequency energy (such as that found in an electrosurgical unit) emitted between two electrodes at the sheath tip to disrupt the fibrotic adhesions. 

Table 4.4 Electrosurgical sheath specifications inner (ID) and outer (OD) diameter in French...

The electrosurgical technique is identical to the laser technique except for the use of an electrosurgical dissection sheath (EDS). The electrosurgical sheath has two bipolar tungsten electrodes that run the length of the sheath. The electrodes are exposed at the distal end of the sheath (Fig. 6.40). Radiofrequency... 

Neuzil P et al (2007) Pacemaker and ICD lead extraction with electrosurgical dissection sheaths and standard transvenous extraction systems results of a randomized trial. Europace 9(2) 98-104... 

Powered sheaths have replaced the telescoping metal, polypropylene, and Teflon sheaths. There are now two powered sheaths available for clinical use for lead extraction. Powered sheaths use an energy source to cut through and vaporize the encapsulating fibrous scar that has grown around the endocardial lead. The first commercially available and FDA approved power sheath is the Spectranetics excimer laser sheath. The second and more recently available is the Cook Vascular Electrosurgical Dissection Sheath. The powered sheaths are available in multiple sizes between 12 and 16 French (Fig. 6.9). The power sheaths are also complemented with outer Teflon sheaths for counterpressure and countertraction. 

---