176-64: Lead extraction with high frequency laser sheaths: a single-center experience

Abstract

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 extraction 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. Mean implantation duration was 96.5 ± 65.5 months (range 24–408). Leads were completely removed 96.2% of the time, with a 98.0% clinical success rate whereby clinical goals associated with the indication for lead extraction were achieved. Patients were 65.7 ± 14.5 years of age (range 18–90), and 74.3% were men. Complications were observed in three patients, including one minor and two major complications. No extraction related mortality occurred. Conclusions: The high frequency 80 Hz laser sheaths allow for safe and effective and successful extraction of chronically implanted PM and ICD leads, combining high procedural success with low complication rates.