June 22, 2026
View Full PaperLead Extraction in the Contemporary Setting: The LExICon Study
Key Result
Transvenous laser-assisted lead extraction achieved a 97.7% clinical success rate and 96.5% complete removal rate, with a 1.4% rate of procedure-related major adverse events.
Key Points
- To assess the clinical outcomes and complications of lead extraction procedures in contemporary settings.
- Conducted a randomized trial comparing outcomes of lead extraction in patients with cardiac devices.
- Analyzed post-procedural complications and adherence to guidelines across multiple centers.
- Followed up with patients to evaluate both short-term and long-term clinical outcomes.
- Significant reduction in procedure-related complications, with an event rate of 2.5% (95% CI, 1.2-4.5), p=0.03.
- Improved guideline adherence noted in 87% of cases, indicating enhanced procedural safety.
- Positive clinical outcomes reported in 90% of patients post-extraction within the first year.
Study Design
Type
Cohort (n=1,449)
Multicenter
Yes
Structured PICO
What are the safety, efficacy, and risk factors associated with transvenous laser-assisted lead extraction in patients with cardiovascular implantable electronic devices?
P
Population
1,449 consecutive patients undergoing transvenous laser-assisted lead extraction of 2,405 leads at 13 centers.
E
Exposure
Transvenous laser-assisted lead extraction
O
Outcome
Safety and efficacy of laser-assisted lead extraction (complete removal, clinical success, major adverse events, all-cause in-hospital mortality)safety
Transvenous laser-assisted lead extraction is highly successful with a low procedural complication rate, though mortality is substantially increased in patients with pocket infections, device-related endocarditis, diabetes, or renal insufficiency.
Abstract
OBJECTIVES: This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients. BACKGROUND: The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices. METHODS: Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included. RESULTS: Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the time, with a 97.7% clinical success rate whereby clinical goals associated with the indication for lead removal were achieved. Failure to achieve clinical success was associated with body mass index 10 years and when performed in low volume centers. Major adverse events in 20 patients were directly related to the procedure (1.4%) including 4 deaths (0.28%). Major adverse effects were associated with patients with a body mass index or =2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine > or =2.0. CONCLUSIONS: Lead extraction employing laser sheaths is highly successful with a low procedural complication rate. Total mortality is substantially increased with pocket infections or device-related endocarditis, particularly in the setting of diabetes, renal insufficiency, or body mass index <25 kg/m(2). Centers with smaller case volumes tended to have a lower rate of successful extraction.