Laser lead extraction in the octogenarian patient

In the United States, patients aged >75 years are the most rapidly growing segment in the population, with an expected increase of 126% by 2050. These patients account for >70% of the pacemakers and up to two thirds of the implantable cardioverter-defibrillators implanted annually. Our aim was to explore the clinical outcomes of device complications in the octogenarian population.

We performed a retrospective chart review of 506 patients undergoing laser lead extraction from January 2004 to September 2009. This population was divided into the following 2 groups based solely on age: octogenarians and nonoctogenarians. These 2 groups were compared on the basis of several characteristics and clinical outcomes. There were 118 patients in the octogenarian group (78 men) and 388 in the nonoctogenarians group (301 men) aged 85±3.8 and 64.2±12.4 years, respectively. A total of 253 leads (atrial, 99; ventricular, 145; coronary sinus, 9) were removed from the patients in the octogenarian group, and 814 leads (atrial, 295; ventricular, 442; coronary sinus, 77) were removed from the patients in the nonoctogenarian group. The main indication for extraction for both groups was infection. The lead implant duration was 59.6±52.8 and 38.6±43.9 months for octogenarians and nonoctogenarians, respectively. There was no significant difference with respect to the proportion of minor (P=0.65), major (P=0.56), and total (P=0.50) complications.

Laser lead extraction is demonstrated to be a safe and effective treatment method in octogenarian patients with multiple comorbidities.