First European experience using excimer laser for the extraction of permanent pacemaker leads

An Excimer Laser system for the extraction of permanent pacemaker leads has been developed by Spectranetics Inc. and Dr. Charles L. Byrd. The laser energy is emitted at the tip of a flexible, fiberoptic 12F sheath that permits the removal of leads with a max. outer diameter of 7.1F. The CVX-300 Excimer Laser source is a xenon chloride laser with an output of 308 nm not visible to the human eye. This cool cutting laser has an absorption depth of 0.06 mm, the energy being absorbed by proteins and lipids. In clinical practice this means that the fibrotic sheaths usually surrounding the leads can be cut without damaging the endothelial wall or the insulation of leads, due to these characteristics the sheath can, however, not pass over tines. For the freeing of lead tips, locking stylets and outer sheaths are combined to perform counter traction.

From 8/96 to 5/97 50 leads (38 atrial, 12 ventricular) from 45 patients (22 females, 23 males, mean age 65.1 years, range 32-94) were extracted using the Excimer Laser at our institution. Mean lead implantation time was 47.7 months (range 10.5-351.7). Indication for extraction was suspected J-wire fracture in 16 leads, prophylactic in 8 leads, infection in 12 leads, exit block in 4 leads and other reasons in 10 leads. Mean extraction time, excluding reimplantation, was 10 minutes (range 1-50). The objective of the procedure (normally complete lead removal) was accomplished in all cases but three. All intended lead replacements were successful. No complications occurred. All patients left the hospital in good condition, one patient died, within 30 days due to progressive heart failure.

Lead extraction with Excimer Laser seems to be a safe and efficacious procedure. However, due to the inherent risks appropriate training and experience are essential. If the initial promising results can be maintained, indications for the removal of permanent pacing leads may widen considerably.