[Excimer laser extraction of pacemaker and defibrillator leads]

Area of Science:

• Cardiology
• Medical Devices
• Surgical Technology

Background:

• Pacemaker or defibrillator lead malfunction/infection necessitates foreign material removal.
• Laser energy offers a novel approach for extracting long-dwelling, fixed leads.
• Limited comparative data exists on laser extraction versus conventional methods.

Purpose of the Study:

• To compare the efficacy and safety of excimer laser lead extraction with conventional methods.
• To evaluate complication rates and success rates for different lead extraction techniques.

Main Methods:

• Utilized Spectranetics excimer laser system (CVX-300) with laser sheaths and a lead locking device.
• Compared laser extraction in 24 patients (45 leads) with conventional methods (manual traction, traction devices, snare catheters, thoracotomy) from 1995-1998 (97 leads).
• Procedures performed under heart-lung machine backup.

Main Results:

• Laser extraction achieved a 96% success rate with minimal fragmentation; conventional methods had a 76% success rate, with fragments remaining in 15% of cases.
• Laser method operation time (93 min) and fluoroscopy time (9.4 min) were comparable to conventional techniques.
• One fatal complication (cerebral hypoxia) occurred with laser extraction; conventional methods resulted in one fatality (sepsis) and four severe complications.

Conclusions:

• Excimer laser extraction facilitates complete removal of leads, preventing late complications from retained fragments.
• Life-threatening complications are possible with both laser and conventional lead extraction.
• Lead extraction procedures should be conducted in specialized centers with advanced monitoring capabilities.