Initial experience using Excimer laser for the extraction of chronically implanted pacemaker and implantable cardioverter defibrillator leads in Japanese patients

Abstract

Background: Given the exponential growth in cardiac device implantations, the need for less invasive lead extraction is increasing. The Excimer laser was approved for lead removal in Japan in 2010. The present study reports the initial experience using this novel technique to extract chronically implanted pacemaker and implantable cardioverter defibrillator (ICD) leads from Japanese patients. Methods and results: We performed a retrospective study of consecutive patients undergoing lead extraction using the laser sheath at a single Japanese center. Patient and lead characteristics, indications, and outcomes were analyzed. From August 2010 to September 2012, a total of 70 leads, including 14 ICD leads, were removed using the laser sheath from 40 patients (26 male, 14 female; age 65.5 ± 18.3 [mean ± SD] years; body mass index 21.8 ± 3.5 kg/m 2). The median implant duration was 87 months (range 13-328 months). Indications were infection (n = 35), venous occlusion (n = 4), and pain (n = 1). The femoral approach was used in combination with the laser technique in five cases. Complete procedural success was achieved with 68 leads (97.1%). Although the electrode tip was left behind in the remaining two leads, the desired clinical outcomes could be achieved; which were defined as clinical success. No cases resulted in failure. There were no major complications, including death and bleeding requiring open-chest surgery. Conclusions: Laser sheaths appear to provide a feasible and effective means of extracting chronically implanted pacemaker and ICD leads in Japanese patients.

Successful transjugular extraction of a lead in front of the anterior scalene muscle by using snare technique

“…Excimer laser sheaths have proved safe and effective for the extraction of leads from an infected CIED [1][2][3][4][5]. Lead extraction with and without an excimer laser system has shown extraction rates of 95% and 64%, respectively.…”

“…Lead extraction with and without an excimer laser system has shown extraction rates of 95% and 64%, respectively. The rate of serious lead extraction-related complications (superior vena cava laceration, severe cardiac tamponade, and massive pulmonary embolism) is approximately 1% [4,5], and death-related injury rates are o1% [1].…”

Lead extraction using a laser system: Techniques, efficacy, and limitations

“…Okamura et al [6] reported their first experience of 40 cases with laser sheath. The median duration of lead implantation was 87 months, which was comparable to the 82 months observed in the LExICon trial [5].…”

Lead extraction using excimer laser sheath—In full swing even in Japan

“…And also in that study, approximately two-thirds of the patients had high BMI ( 25 kg/m 2 ). Contrarily, only 10% of patients had a BMI >25 kg/m 2 in the Japanese population [6]. Moreover, the success rate of complete removal using SLS II was high (100%) among those patients without major life-threatening complications.…”

“…At present, lead extraction using excimer laser is not common in the Asian region, however, it is becoming available in some Asian countries. In the current issue of the Journal of Cardiology, Okamura et al [6] reported a series of extraction results using excimer laser sheath (SLS II) in Japanese patients in the Kansai area. This may be the first report of Japanese experience in a single center, because SLS II was approved in 2010 in Japan.…”