Laser-assist during extraction of chronically implanted pacemaker and defibrillator leads

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Chronic implantation of cardiac pacing and defibrillator leads presents extraction challenges, often necessitating open surgical procedures.
• Evaluating percutaneous laser-assisted sheath techniques offers a less invasive alternative for lead removal.

Purpose of the Study:

• To assess the efficacy and safety of laser-assisted sheath techniques for extracting chronically implanted leads.
• To determine the necessity of these percutaneous methods in lead extraction procedures.

Main Methods:

• A study involving 128 patients and 229 leads (pacing and defibrillator) extracted between January 1999 and August 2001.
• Analysis of lead implantation duration, indications for extraction (e.g., erosion, infection, dysfunction), and use of laser techniques.

Main Results:

• Laser techniques were predominantly used for leads implanted >1 year (56%) versus <1 year (16%).
• Complete extraction was achieved in 88% of cases; no patients required cardiac surgery.
• Complications were infrequent and included vein injury, thrombosis, and perforation, with no procedure-related deaths.

Conclusions:

• Laser-assisted lead extraction is a safe and effective method, best performed in an operating room setting.
• This technique is recommended for long-term leads, unless gross infection causing sepsis is present.
• Laser techniques have largely replaced open surgical removal for retained leads.