Excimer laser for pacemaker and defibrillator lead extraction: techniques and clinical results

Area of Science:

• Cardiology
• Medical Devices
• Surgical Techniques

Background:

• Chronic pacemaker and defibrillator leads require removal due to infection, interference, or redundancy.
• Lead removal is technically challenging due to extensive adhesions over time.
• Excimer laser sheaths offer a facilitated approach to chronic lead extraction.

Purpose of the Study:

• To analyze the experience with excimer laser extraction of chronically implanted leads.
• To evaluate the success and complication rates of this technique.

Main Methods:

• Utilized an excimer laser sheath system (Spectranetics Corporation) for lead extraction.
• Extracted 50 chronically implanted leads in 34 male patients (mean age 64 years).
• Average lead implantation duration was 5.0 years; leads were 2/3 pacemaker, 1/3 defibrillator.

Main Results:

• Achieved 100% clinical success with complete removal of 48 out of 50 leads.
• No major complications occurred; one case of subclavian vein thrombosis and two minor air embolisms.
• Failure to advance the laser sheath occurred in 18% of cases, primarily due to calcified adhesions.

Conclusions:

• Excimer laser extraction greatly facilitates the removal of chronically implanted cardiac leads.
• The technique demonstrates a high success rate and low complication profile.
• Calcified lead adherence is the main limitation, manageable with specific strategies like upsizing sheaths or using stainless-steel sheaths.