US20120095479A1 - Endocardial Lead Removing Apparatus - Google Patents

Abstract

The invention provides an apparatus having a tubular member for receiving an endocardial lead implanted within a patient's body. Disposed generally at a distal end of the tubular member is at least one blade or cutting surface. An adjustment mechanism moves the blade between retracted and extended positions to engage the cutting surface with the endocardial lead to cut the lead. Once severed, the cut portion of the lead remains within an inner channel of the tubular member and the apparatus and cut portion of the lead are removed from within the patient. Various embodiments include the blade pivotally connected to the distal end of the tubular member and activated by a wire adjustment mechanism. Others include a metallic wire for slicing through the lead. Still others include a pneumatically actuated adjustment mechanism that inflates to move the blade and engage the cutting surface with the lead.

Description

FIELD OF THE INVENTION
• This invention relates generally to an endocardial lead removing apparatus and, more particularly, to an apparatus that cuts the endocardial lead and, in some embodiments, captures the cut portion to remove the lead from the patient's body.
BACKGROUND OF THE INVENTION
• In the past, various types of endocardial leads and electrodes have been introduced into different chambers of a patient's heart, including among other locations, the right ventricle, right atrial appendage, and atrium, as well as the coronary sinus. These flexible leads are often composed of an insulator sleeve that contains an implanted helical coil conductor that is attached to an electrode tip. This electrode is placed in contact with myocardial tissue by passage through a venous access, often the subclavian vein or one of its tributaries, which leads to the endocardial surface of the heart chambers. The tip with the electrode contact is held in place by trabeculations of myocardial tissue. In some cases, active fixation leads are fastened by screw into the myocardial tissue.
• The tips of many available leads often include flexible tines, wedges, or finger-like projections which extend radially outward and usually are molded from and integral with the insulating sheath of the lead. These tines or protrusions allow surrounding growth of tissue in chronically implanted leads to fix the electrode tip in position in the heart and prevent dislodgement of the tip during the life of the lead. In “acute placement” of the electrode or lead tip, a blood clot forms about the flanges or tines (due to enzymes released as a result of irritation of the trabeculations of myocardial tissue by the presence of the electrode tip) until scar tissue eventually forms, usually in three to six months. The tines or wedges or finger-like projections allow better containment by the myocardial trabeculations of muscle tissue and prevent early dislodgement of the lead tip.
• Although the state of the art in implemented pulse generator or pacemaker technology and endocardial lead technology has advanced considerably, endocardial leads nevertheless occasionally fail, due to a variety of reasons, including breakage of a lead, insulation breaks, breakage of the inner helical coil conductor and an increase in electrode resistance. Furthermore, in some instances, it may be desirable to electronically stimulate different portions of the heart than are presently being stimulated with the leads already implanted. There are a considerable number of patients who have one or more, and sometimes as many as four or five, unused leads in their veins and heart.
• Although it obviously would be desirable to easily remove such unused leads, in the past surgeons usually have avoided attempts to remove inoperative leads because the risk of removing them exceeded the risk of leaving them in. The risks of leaving unused myocardial leads in the heart and venous path include increased likelihood that an old lead may facilitate infection, which in turn may necessitate removal of the lead to prevent continued bacteremia and abcess formation. Furthermore, there is an increased likelihood of the formation of blood clots in the atrial chamber about entangled leads. Such clots may embolize to the lung and produce severe complications and even fatality. Furthermore, the presence of unused leads in the venous pathway and inside the heart can cause considerable difficulty in the positioning and attachment of new endocardial leads in or to the heart.
• Removal of an inoperative lead sometimes can be accomplished by applying traction and rotation to the outer free end of the lead, but only if done prior to fixation of the lead tip in the trabeculations of myocardial tissue by scar tissue formation or large clot development. Even then, it is possible that a clot has formed so the removal of the leads causes various sized emboli to pass to the lungs, producing severe complications.
• In cases where the lead tip has become attached by scar tissue to the myocardial wall, removal of the lead always has presented problems and risks. Porous lead tips that are sometimes used may have an in-growth of scar tissue attaching them to the myocardial wall. Sufficient traction on such leads in a removal attempt could cause disruption of the myocardial wall prior to release of the embedded lead tip. The tines or flanges of other types of leads that are not tightly scarred to the myocardial wall present similar risks. Even if screw-in tip electrodes are used, wherein the tips theoretically can be unscrewed from the myocardial wall, unscrewing of such tips may be prevented by a channel of scar tissue and endothelium that surrounds the outer surface of the lead along the venous pathway. Such “channel scar” tissue prevents withdrawal because of tight encasement of the lead. Continual strong pulling or twisting of the outer free end of the lead could cause rupture of the atrial wall or the ventricular wall if there is such tight circumferential encasement of adherent channel scar tissue in the venous path. Such tight encasement by scar tissue in the venous pathway and in the trabeculations of the myocardial wall typically occurs within six months to a year of the initial placement of the lead.
• The risks of removing the lead by such traction and rotation of the lead may be high enough so that, if it becomes imperative that the lead be removed (as in the case of infection), many surgeons have elected to open the patient's chest and surgically remove the lead rather than attempt removal by applying traction and rotation thereto.
• Clearly, there is a need for an apparatus for extracting endocardial leads from a patient's body with minimized risk to the patient.
SUMMARY OF THE INVENTION
• To address these and other drawbacks in the existing art, the present invention comprises an apparatus for grasping a free end of an endocardial lead and cutting the lead as near as possible to the lead's embedded electrode. Once the lead is severed, a majority of the lead is removed thereby, leaving just a small distal portion of the lead within the patient.
• Specifically, the present invention comprises an apparatus having a tubular member for receiving the lead. Positioned generally at a distal end of the tubular member is at least one blade or cutting surface. In some embodiments, an adjustment mechanism actuates the blade between extended and retracted positions to engage the cutting surface with the lead to cut the lead. Once severed, the cut portion of the lead is disposed within the tubular member and the apparatus is removed from within the patient.
• Other aspects of the invention will be apparent to those skilled in the art after reviewing the drawings and the detailed description below.
BRIEF DESCRIPTION OF THE DRAWINGS
• The present invention will now be described, by way of example, with reference to the accompanying drawings, in which:
• FIG. 1 illustrates a perspective view of an endocardial lead removing apparatus of a first embodiment of the present invention;
• FIG. 2A illustrates a perspective view of a distal end of an inner tubular member of the first embodiment of the present invention;
• FIG. 2B illustrates a perspective view of a distal end of an outer tubular member of the first embodiment of the present invention;
• FIG. 3A illustrates a perspective view of the distal end of the inner tubular member of the first embodiment of the present invention having an angled cutting surface;
• FIG. 3B illustrates a perspective view of the distal end of the outer tubular member of the first embodiment of the present invention having an angled cutting surface;
• FIG. 3C illustrates a first embodiment of the present invention having a T-shaped cutting channel;
• FIG. 4 illustrates a cross-sectional view along a longitudinal axis of a tubular member of an endocardial lead removing apparatus of another embodiment of the present invention;
• FIG. 5 illustrates a perspective view of the endocardial lead removing apparatus of an embodiment including an insert and adjustment mechanism;
• FIGS. 6A-6C illustrate a perspective view of an endocardial lead removing apparatus of another embodiment of the present invention;
• FIG. 7 illustrates an end view of the endocardial lead removing apparatus of one embodiment, without limitation;
• FIGS. 8A-8C illustrate a perspective view of an alternate embodiment of the endocardial lead removing apparatus of an embodiment having only one blade;
• FIG. 9 illustrates a perspective view of an endocardial lead removing apparatus of another embodiment of the present invention;
• FIGS. 10A-10B illustrate a perspective end view of the endocardial lead removing apparatus of one embodiment having teeth retracted and extended, respectively;
• FIG. 11 illustrates a perspective view of an endocardial lead removing apparatus of a fifth embodiment of the present invention; and
• FIG. 12 illustrates a perspective end view of the endocardial lead removing apparatus of the fifth embodiment including a blade and adjustment mechanism.
DETAILED DESCRIPTION
• Referring generally toFIGS. 1-12, various embodiments of an endocardial lead removing apparatus are generally referred to at10.
• Referring toFIG. 1, in some embodiments, the invention comprises anapparatus10 that includes anouter tubular member12 and aninner tubular member14. Eachtubular member12,14 includes aninner cavity16. Theinner tubular member14 is received within theinner cavity16 of the outertubular member12. Both of themembers12,14 have distal ends18 and proximal ends20 with the proximal ends20 of eachmember12,14 having ahandle22. As shown, the outertubular member12 has a generally shorter length than theinner tubular member14 and thehandles22 generally abut at the proximal ends20. Further, themembers12,14 are contemplated to be made of a metallic material such as hardened stainless steel; however other materials, such as rigid plastic, are also contemplated by the present invention.
• Generally disposed at the distal ends18 of theouter member12 and theinner member14 are first andsecond channels24,26, respectively. As shown inFIGS. 2A-2B and3A-3B, without limitation, thechannels24,26 are generally L-shaped each having alongitudinal leg28 and alateral leg30. Thelateral legs30 of eachchannel24,26 are generally orthogonal to thelongitudinal legs28. When assembled and having theinner tubular member14 received in theinner cavity16 of the outertubular member12, the first andsecond channels24,26 are opposed. As such, thelateral legs30 of eachchannel24,26 align and extend orthogonally from thelongitudinal legs28 in opposite directions. Further, each of thechannels24,26 includes at least one cuttingsurface32. In some embodiments, without limitation, the invention may also comprise aninner tubular member14 disposed in anouter tubular member12 each with a T-shaped channel that forms a double blade with one or more cutting surfaces32 on each member (FIG. 3C).
• Referring toFIGS. 2A-2B and3A-3B, the distal ends18 of the inner and outertubular members12,14 are illustrated. Thechannels24,26 are bounded by a plurality of edges34. Specifically, thelateral legs30 of eachchannel24,26 are bounded by threeedges34a,34band34c.At least one of the three edges34a-cis the cuttingsurface32 described above. As contemplated for the illustrated embodiment, the cuttingsurface32 isedge34b.Alternatively, the present embodiment could include multiple cutting surfaces32 such as each of the three edges34a-c. Referring toFIGS. 3A-3B, theedge34bmay be generally angled to improve cutting efficiency of theapparatus10.
• In operation, the first embodiment ofapparatus10 ofFIGS. 1-3 is inserted within a patient's chest cavity, blood vessel, or other anatomical part containing a lead (not shown) and receives a lead100 (shown in phantom inFIG. 1) within theinner cavity16 of theinner tubular member14. Once the distal ends18 of theapparatus10 are positioned as near as possible to the embedded electrode (not shown) within the patient's body thelead100 is received within thechannels24,26. Each of thetubular members12,14 are independently rotatable and when rotated in opposite directions thelead100 is captured between the cutting surfaces32 of eachchannel24,26. Additional torque applied to thehandles22 and further rotation of themembers12,14 cuts through thelead100. The severed portion of thelead100 remains within theinner cavity16 of theinner tubular member14 and theapparatus10 is removed from the patient's body.
• Another embodiment of theapparatus10 is shown inFIGS. 4-5. The embodiment includes atubular member212 having adistal end218 and aproximal end220. Thetubular member212 is generally flexible and made from a polymer material. Further, thetubular member212 may include reinforcements such as a braid or compressed coil (not shown) to strengthen thetubular member212 and resist compression during operation.
• Disposed within aninner cavity216 of thetubular member212 is ametallic wire236. In some embodiments, without limitation, a filament or strong cord, optionally diamond-coated, or other element suitable for cutting, may be substituted for the metallic wire. Themetallic wire236 has opposite ends238 extending from theproximal end220 of thetubular member212. Optionally, the opposite ends238 of themetallic wire236 include handles222. Themetallic wire236 extends through theinner cavity216 and outwardly at thedistal end218 thereby forming aloop240. It is contemplated that themetallic wire236 is made from stainless steel or nickel titanium and has a diameter of about 0.005 inches to about 0.030 inches; however, other materials and diameters are also contemplated by the present invention.
• Also disposed within theinner cavity216 of thetubular member212 is at least onelumen242 for receiving themetallic wire236. The lumen could be a second polymer lumen, even include a lubricious sleeve (such as polytetrafluoroethelene (PTFE) or FEP). Thelumen242 may be made from a flexible material such as nickel titanium, although other materials are also contemplated. Thelumen242 is disposed at one side of theinner cavity216. Thelumen242 extends the length of thetubular member212 and when only onelumen242 is contemplated the opposite ends238 of themetallic wire236 are both disposed therein. Alternatively, twolumen242, one for eachopposite end238 of themetallic wire236, may be positioned adjacent to each other at one side of theinner cavity216 of thetubular member212.
• In some embodiments, the invention also comprises an adjustment mechanism246 (FIG. 5). Theadjustment mechanism246 moves the opposite ends238 of themetallic wire236 to reduce or expand the size of theloop240. As shown, theadjustment mechanism246 includes arotatable pin248 disposed within theinner cavity216 at one side, optionally within acatheter242. One of the opposite ends238 of themetallic wire236 is fixed to therotatable pin248. The second of the opposite ends238 is fixed to atension mechanism250 such as a spring and the like. Ahandle222 is disposed at aproximal end220 to rotate therotatable pin248 and wind themetallic wire236 thereabout.
• In operation, theapparatus10 ofFIG. 4 includes themetallic wire236 extending at thedistal end218 of thetubular member212 to form theloop240. Theapparatus10 is inserted within a patient and positioned near thelead100. The free end of thelead100 is received within theinner cavity216 of thetubular member212 and extends outwardly at thedistal end218 and through theloop240. The opposite ends238 of themetallic wire236 are moveable to reduce the size of theloop240. When themetallic wire236 is disposed in asingle lumen242 or twoadjacent lumen242, as illustrated inFIG. 4, the opposite ends238 are simply pulled through thetubular member212 and theloop240 is reduced in size. Accordingly themetallic wire236 of theloop240 slices through thelead100. The severed portion of thelead100 remains within theinner cavity216 of thetubular member212 and the apparatus is removed from the patient.
• Alternatively, as illustrated inFIG. 5, in some embodiments, twoseparate lumens242 are employed and theadjustment mechanism246 is utilized. One lumen is preferably adjacent or nearly so. As described above, thelead100 is received in theinner cavity216 and extends outwardly at thedistal end218 and through theloop240. Theadjustment mechanism246 is actuated by rotating therotatable pin248, preferably usinghandle220. Accordingly, one of the opposite ends238 is wound around therotatable pin248 and the size of theloop240 is reduced. Thelead100 is captured between theinsert244 and theloop240. The cutting surface232 of theinsert244 and themetallic wire236 of theloop240 slice through thelead100. The severed portion of thelead100 remains within theinner cavity216 of thetubular member212 and theapparatus10 is removed from the patient.
• Now referring toFIGS. 6-8, another embodiment of theapparatus10 of the present invention is illustrated. Again theapparatus10 includes atubular member312 having adistal end318 and aproximal end320. Thetubular member312 is preferably a metal coil shaft to allow for flexibility while resisting compression during operations. However, any material is contemplated by the present invention.
• At least oneblade352 is pivotally connected to thedistal end318 of thetubular member312. As seen inFIGS. 6A-6C, twoblades352 are pivotally connected at thedistal end318 by apivot pin354. Each of theblades352 is generally arcuate to define acutting surface332. Further, theblades352 are moveable between a retracted position (FIG. 6A) and an extended position (FIGS. 6B-6C).
• As an alternate configuration, seen inFIGS. 8A-8C, theapparatus10 includes only oneblade352. Again, theblade352 is pivotally connected at thedistal end318 by thepivot pin354. Theblade352 is generally arcuate to define aninner cutting surface332. Thedistal end318 of thetubular member312 is generally angled and defines asecond cutting surface332. Theblade352 is moveable between the retracted position (FIG. 8A) and the extended position (FIGS. 8B-8C).
• Theapparatus10 of another embodiment further includes anadjustment mechanism346. Theadjustment mechanism246 pivots the blade(s)352 between the retracted and extended positions. By way of example, theadjustment mechanism346 may include an outer sheath (not shown) that receives thetubular member312 and is moveable longitudinally along thetubular member312. A distal end of the outer sheath generally aligns with thedistal end318 of thetubular member312 and engages the blade(s)352. Continued longitudinal movement of the outer sheath urges the blades(s)352 about thepivot pin354 to pivot from the retracted to the extended position.
• As a further example and illustrated inFIGS. 6 and 8, theadjustment mechanism346 includes apull wire356. Thepull wire356 is attached to the blade(s)352 and extends within aninner cavity316 of thetubular member312. A proximal end of thepull wire356 is preferably joined to ahandle322.
• In operation, the embodiment ofapparatus10 ofFIGS. 6-8 is inserted within a patient's heart or other anatomical part containing a lead and receives thelead100 within theinner cavity316 of thetubular member312. Once thedistal end318 of theapparatus10 is positioned as near as possible to the embedded electrode tip within the patient's body theadjustment mechanism346 is actuated. As shown, tension is applied to thepull wire356, preferably at thehandle322, and the blade(s)352 pivot about thepivot pin354. Thelead100 is captured between the cuttingsurfaces332 of the two blades352 (FIGS. 6A-6C). Alternately, thelead100 is captured between the cuttingsurface332 of the oneblade352 and the cuttingsurface332 of thedistal end318 of the tubular member312 (FIGS. 8A-8C). Additional tension is applied to thepull wire356 and the cutting surfaces332 cut through thelead100. The severed portion of thelead100 remains within theinner cavity316 of thetubular member312 and theapparatus10 is removed from the patient's body.
• Referring toFIGS. 9-10, another embodiment of theapparatus10 of the present invention is illustrated. Theapparatus10 includes atubular member412 having adistal end418 and aproximal end420. Thetubular member412 defines a longitudinal axis A-A and aninner cavity416. Thetubular member412 is generally flexible and is preferably made from a plastic or polymer material. However, any material is contemplated by the present invention.
• At least onetooth458 is generally positioned at thedistal end418 of thetubular member412 within theinner cavity416. Thetubular member412 includes atubular wall460 defining theinner cavity416. Thetooth458 connects to thetubular wall460. The at least onetooth458 includes a plurality ofedges462 and at least one of theedges462 is a cuttingsurface432. As illustrated, this embodiment of theapparatus10 comprises fourteeth458. However, the present invention contemplates a plurality ofteeth458 or even only onetooth458. As shown the fourteeth458 of the illustrated embodiment are generally triangular; however, the present invention also contemplates asymmetrically shapedteeth458.
• Theteeth458 of this embodiment are moveable between a retracted position and an extended position. The retracted position, as shown inFIG. 10A, positions theteeth458 generally parallel to thetubular wall460 of thetubular member412. In contrast, the extended position, as shown inFIG. 10B, positions theteeth458 generally orthogonal to thetubular wall460 of thetubular member412. Accordingly, when theteeth458 are in the extended position thetubular member412 has a reduced inner diameter.
• Ahinge mechanism464 connects theteeth458 to thetubular wall460 of thetubular member412. Thehinge mechanism464 adjusts theteeth458 between the retracted position and the extended position to place the cutting surfaces432 of theteeth458 in contact with thelead100. Optionally, theapparatus10 may include an actuator (not shown) for adjusting theteeth458 between the positions. Otherwise, the movement of theteeth458 between the positions is manually actuated by ahandle422 at theproximal end420 of thetubular member412.
• In operation, this embodiment ofapparatus10 is inserted within a patient's heart or other anatomical part containing a lead and positioned near the embedded electrode tip. The free end of thelead100 is received within theinner cavity416 of thetubular member412. As thetubular member412 is extended over thelead100, theteeth458 are in the retracted position and generally parallel to thetubular wall460. Once thedistal end418 of thetubular member412 is positioned as near as possible to the embedded electrode tip, thetubular member412 is retracted. Extension and retraction of thetubular member412 is facilitated by thehandle422 at theproximal end420. When thetubular member412 is retracted, contact between the cuttingsurface432 and thelead100 urges theteeth458 to the extended position generally orthogonal to thetubular wall460. Accordingly, thelead100 is captured by theteeth458 in the reduced diameter of the tubular member. Continued extension and retraction of thetubular member412 over thelead100 moves theteeth458 between the retracted and extended positions. The cutting surfaces432 repetitively contact thelead100 and cut through. Once severed, the cut portion of thelead100 remains within theinner cavity416 of thetubular member412 and theapparatus10 is removed from the patient.
• Referring toFIGS. 11-12, a fifth embodiment of theapparatus10 of the present invention is illustrated. Theapparatus10 includes atubular member512 defining atubular wall560 and a longitudinal axis A-A. Thetubular member512 is generally flexible and made from a plastic or polymer material; however, any material is contemplated by the present invention. Thetubular member512 andtubular wall560 define aninner cavity516. Theinner cavity516 is generally offset from the longitudinal axis A-A of thetubular member512 in order to accommodate ablade552 andadjustment mechanism546 within thetubular wall560.
• Theapparatus10 includes theblade552 disposed within thetubular wall560 of thetubular member512. Theblade552, by way of theadjustment mechanism546, is moveable between a retracted position and an extended position. Further, theblade552 includes a generallyarcuate cutting surface532.
• Theadjustment mechanism546 of the fifth embodiment is pneumatically actuated. As seen inFIG. 12, theadjustment mechanism546 includes aninflatable device566, such as a balloon and the like. Theinflatable device566 is disposed within thetubular wall560 and placed adjacent theblade552 at an end opposite the cuttingsurface532. Expansion and retraction of theinflatable device566 expands or retracts the cuttingsurface532 of theblade552 into theinner cavity516 of the tubular member.
• Further, theadjustment mechanism546 includes a guide comprising of two projectingarms568 and atrack570. The guide facilitates movement of theblade552 between the retracted and extended positions to insert the cuttingsurface532 into theinner cavity516. Theblade552 is adapted to receive first ends572 of each of the projectingarms568. As illustrated inFIG. 12, the blade includes anotch574. Received within thenotch574 are the first ends572 of the projectingarms568. Accordingly, theprojection arms568 are generally parallel to the cuttingsurface532 of theblade552. The projectingarms568 slide within thenotch574. Second ends576 of the projectingarms568 are received within thetrack570. Thetrack570 is disposed within thetubular wall560 and extends circumferentially about thetubular member512.
• In operation, the fifth embodiment ofapparatus10 ofFIGS. 11-12 is inserted within a patient's heart or other anatomical part containing a lead and positioned as near as possible to the electrode tip embedded within the body. The free end of thelead100 is received within theinner cavity516 of thetubular member512. Air is supplied through a catheter (not shown) to theinflatable device566 or balloon. Theinflatable device566 expands thereby urging theblade552 from the retracted position to the expanded position and inserting the cuttingsurface532 of theblade552 into theinner cavity516. Further, as theblade552 moves from the retracted position to the expanded position the second ends576 of the projectingarms568 move along thetrack570 sliding within thenotch574 as appropriate, to accommodate the varying width of theinner cavity516. The cuttingsurface532 of theblade552 cuts through thelead100. Once severed, the cut portion of thelead100 remains within theinner cavity516 and theapparatus10 is removed from the patient.
• While the present invention has been particularly shown and described with reference to the foregoing preferred and alternative embodiments, it should be understood by those skilled in the art that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention without departing from the spirit and scope of the invention as defined in the following claims. It is intended that the following claims define the scope of the invention and that the apparatus within the scope of these claims and their equivalents be covered thereby. This description of the invention should be understood to include all novel and non-obvious combinations of elements described herein, and claims may be present in this or a later application to any novel and non-obvious combination of these elements. The foregoing embodiments are illustrative, and no single feature or element is essential to all possible combination that may be claimed in this or a later application. Where the claims recite “a” or “a first” element of the equivalent thereof, such claims should be understood to include incorporation of one or more such elements, neither requiring nor excluding two or more such elements.

Claims (22)

1-49. (canceled)

50. An endocardial lead removing apparatus for removing a lead implanted within a patient, comprising:

a tubular member having a proximal end and a distal end;

at least one blade pivotally connected to said distal end and moveable between a retracted position and an extended position; and

an adjustment mechanism for pivoting said at least one blade between said retracted and extended positions.

51. The apparatus ofclaim 50, wherein said at least one blade is coupled to said distal end of said tubular member by at least one pin to pivot said at least one blade between said retracted and extended positions.

52. The apparatus ofclaim 50, wherein said adjustment mechanism includes an outer sheath receiving said tubular member and moveable longitudinally along said tubular member.

53. The apparatus ofclaim 52, wherein a distal end of said outer sheath engages said at least one blade to pivot from said retracted position to said extended position.

54. The apparatus ofclaim 50, wherein said adjustment mechanism includes a wire attached to said at least one blade and disposed within said tubular member such that applying tension to said wire pivots said at least one blade from said retracted position to said extended position.

55. The apparatus ofclaim 54, wherein a proximal end of said wire is joined to a handle.

56. The apparatus ofclaim 50, wherein said tubular member is metallic.

57. The apparatus ofclaim 50, wherein said at least one blade is generally arcuate to define an inner cutting surface.

58. An endocardial lead removing apparatus for removing a lead implanted within a patient, comprising:

a tubular member having a proximal end and a distal end; and

a first and second blade pivotally connected to said distal end and moveable between a retracted position and an extended position.

59. The apparatus ofclaim 58, wherein said first and second blade are generally arcuate to define an inner cutting surface.

60. The apparatus ofclaim 58, wherein said first and second blade are operatively coupled to a pull wire and wherein said is pull wire is configured to pivot said first and second blade from said retracted position to said extended position upon application of tension force.

61. The apparatus ofclaim 58, further comprising an adjustment mechanism for pivoting said first and second blade between said retracted and extended positions.

62. The apparatus ofclaim 58, further comprising an adjustment mechanism for pivoting said first and second blade between said retracted and extended positions.

63. The apparatus ofclaim 60, wherein the pull wire extends from an inner cavity of the tubular member.

64. The apparatus ofclaim 60, further comprising a handled coupled to a proximal end of the pull wire.

65. The apparatus ofclaim 58, wherein an inner portion of the tubular member is configured to receive a severed portion of the lead.

66. An endocardial lead removing apparatus for removing a lead implanted within a patient, comprising:

a tubular member having a proximal end and a distal end;

at least one blade pivotally connected to said distal end and moveable between a retracted position and an extended position, wherein the at least one blade is configured to sever the lead in the extended position.

67. The apparatus ofclaim 66, wherein an inner portion of the tubular member is configured to receive a severed portion of the lead.

68. The apparatus ofclaim 66, wherein said at least one blade is operatively coupled to a pull wire and wherein said is pull wire is configured to pivot said at least one blade said retracted position to said extended position upon application of tension force.

69. The apparatus ofclaim 66, wherein said at least one blade is generally arcuate to define an inner cutting surface.

70. The apparatus ofclaim 68, further comprising a handled coupled to a proximal end of the pull wire.

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