[Pacing lead extraction using an excimer laser sheath under general anesthesia].

Area of Science:

• Cardiology
• Anesthesiology
• Medical Devices

Background:

• Pacemaker and implantable cardioverter-defibrillator (ICD) lead extraction is a critical procedure.
• The excimer laser sheath technique offers easier and faster lead removal.
• Limited data exists on anesthetic management during laser sheath lead extraction.

Observation:

• Two cases of pacemaker lead extraction using an excimer laser sheath under general anesthesia were managed.
• Procedures were conducted in an operating theater with cardiovascular surgeons on standby.
• Extensive preparation included vascular access for potential cardiopulmonary support and sterile draping for cardiac surgery.

Findings:

• The first case was completed without complications.
• The second case required sternotomy by cardiac surgeons for lead separation from vessels, with no bleeding.
• Both cases highlight the need for meticulous planning and interdisciplinary collaboration.

Implications:

• General anesthesia for laser sheath lead extraction necessitates comprehensive preparation for potential complications like massive bleeding.
• A multidisciplinary team approach involving cardiologists, cardiovascular surgeons, anesthesiologists, and medical engineers is vital for safety.
• This approach ensures readiness for emergent interventions, such as cardiopulmonary bypass, if hemodynamic collapse occurs.