Lead Extraction with High-Frequency Laser Sheaths: A Single-Center Experience

Objectives: The aim of the study was to present a single-center experience of pacemaker (PM) and implantable cardioverter defibrillator (ICD) laser lead extraction using new laser sheaths, which deliver a rate of 80 pulses per second, mainly as minimally invasive procedures. Methods: Data from 239 leads and 101 procedures were collected between January 2012 and August 2015. Indications for lead extractions were: local infection 49.5%, systemic infection 29.7%, lead dysfunction 15.8%, upgrade from PM to ICD 3.0% and tricuspid insufficiency 2.0%. Extraction procedures were performed in hybrid operating room with patients under general anesthesia with continuous invasive arterial blood pressure and 3D TEE monitoring. Results: The high frequency laser technique was used to extract 137 pm and 102 ICD leads. Patients were 65.7 ± 14.5 years of age (range 18 - 90), and 74.3% were men. Mean implantation duration was 96.5 ± 65.5 months (range 24 - 408). Leads were completely removed in 96.2%, with a 98.0% clinical success rate whereby clinical goals associated with the indication for lead extraction were achieved. Complications were observed in three patients, including one minor and two major complications (Pocket hematoma, pericardial effusion and emergent sternotomy for SVC perforation). No extraction related mortality occurred. Conclusion: The high frequency 80 Hz laser sheaths allow for safe, effective and successful extraction of chronically implanted PM and ICD leads, combining high procedural success with low complication rates.