Abstract 11319: Success and Complication Rates in Cardiac Implantable Electronic Device (CIED) Laser Lead Extractions: A Systematic Review

Abstract

Introduction: Laser extraction sheaths are a valuable tool for complex CIED lead extractions. While there is evidence to suggest they have a higher complication rate than simple traction, there has been no systematic review of the literature regarding the success and complication rate associated with laser lead extractions. Objective: To conduct a systematic review investigating success and complication rates of CIED lead extractions using laser sheaths. Methods: A search was performed of studies published between January 1, 2000-August 29, 2019 indexed on Medline, EMBASE and Cochrane. Inclusion criteria were: (a) transvenous removal of ICD, pacemaker or CRT device leads, (b) Age≥18, (c) n>100 patients. Exclusion criteria were: (a) generator only procedures, (b) planned surgical extractions, (c) data prior to 2000. From these studies, we further selected papers containing laser lead extractions only, or laser-only cohorts, that reported on our outcomes. Outcomes: Complete procedural success, major and minor complications and procedure-related mortality. Results: 2307 abstracts were screened after de-duplication resulting in 164 papers. Of these papers, 11 were selected based on our inclusion criteria. All included studies follow the Heart Rhythm Society 2009 and 2017 or North American Society of Pacing and Electrophysiology 2000 guidelines criteria for extraction, major complications, minor complications and procedural success. Complete procedural success was reported by 9 studies which ranged from 89.26-100%; median 93.5% (IQR 89.26-97.56%). All 11 studies reported major complications which ranged between 1.08-6.25%; median 1.98% (IQR 1.50-3.57%). 8 reported minor complications which ranged from 1.09-5.69%; median 4.52% (IQR 3.80-4.94%). Procedure-related mortality was reported by 10 studies which ranged from 0-2.68%; median 0.10% (IQR 0.00-0.48%), while all-cause mortality during hospitalization was reported by 7 studies ranging from 0-2.17%; median 0.23% (IQR 0.00-1.18%). Conclusion: Laser lead extraction is associated with a high success rate of complete removal. Mortality rates due to procedure related factors are very low, however major and minor complications are not uncommon.