Total laser cycles-a measure of transvenous lead extraction difficulty

Several variables have been identified as predictors for difficult or complicated transvenous lead extraction (TLE), including age and number of implanted leads, as well as patient's age; however, a standard measure of TLE difficulty has not been described.

Total laser cycles (TLCs) delivered during laser-assisted TLE is an objective variable that could reflect the difficulty of TLE. This study investigated whether TLC is correlated with known predictors of difficult TLE.

In a retrospective study of TLE procedures using the laser sheath, we analyzed TLC delivered and compared it to established predictors of procedural failure and complications.

Of 166 patients undergoing TLE, the laser sheath (SLS II or Glidelight, Spectranetics Inc.,) was used as the primary extraction sheath in 130 patients, and 100 patients had complete TLC data available. The mean age of the oldest lead (AOL) was 7.1 ± 3.2 years with a median of 6.91 (interquartile range [IQR] 0.48-16.69) years, and 1.6 ± 0.7 leads (range, 1-4) were extracted per procedure. Two thirds of procedures involved ICD leads. Clinical success was 99%, with one patient (1%) experiencing a major complication. Median TLC delivered was 1165 (IQR, 567-2062; range, 49-9522). TLC was positively correlated with AOL (r = 0.227, p = 0.023), and the combined age of leads was extracted (r = 0.307, p = 0.002). TLC was also positively correlated with number of leads extracted per procedure (ρ = 0.227, p = 0.024). There was a non-significant negative trend towards correlation between TLC and patient's age (r = -0.112, p = 0.268).

TLC showed significant correlation with known predictors of difficulty during TLE using the laser sheath. TLC is an objective method to report the difficulty of TLE and could usefully be reported in future series of laser lead extractions.