Laser assisted extraction of pacemaker and implantable defibrillator leads

Section: Discussionmentioning

confidence: 99%

Laser Lead Extraction in Congenital Heart Disease: A Case‐Controlled Study

McCanta

Kong

Carboni

et al. 2013

“…In both conventional and laser extraction methods, advancement of the sheath may fail due to the “snowplough” effect at the advancing sheath tip if sufficient spacing is not allowed between the lead and the sheath 3 . Thus, the ability to gauge the appropriate size of sheath is common to both techniques 12 . It remains to be seen whether operators that do not have experience with conventional extraction methods demonstrate a learning curve with laser lead extraction.…”

Section: Discussionmentioning

confidence: 99%

“…3 Thus, the ability to gauge the appropriate size of sheath is common to both techniques. 12 It remains to be seen whether operators that do not have experience with conventional extraction methods demonstrate a learning curve with laser lead extraction.…”

Section: Discussionmentioning

confidence: 99%

Laser Lead Extraction: Is There a Learning Curve?

Ghosh

Yee

Klein

et al. 2005

Laser extraction of device leads offers an attractive alternative to countertraction and electrosurgical dissection sheath, potentially increasing efficacy and reducing complications. Wider adoption of this technology depends on relative ease of use. We report the experience of a new center to define the "learning curve." We performed 76 laser lead extractions in 75 patients (age 63 +/- 17 years, 59 male) from July 2001 to January 2004. Two experienced device implanters who were novice extractors underwent a 2-day site visit to a high volume extraction center for training. Lead extractions were performed in the operating room with immediate surgical backup. The indication for extraction was infection in 39 (systemic in 15), erosion or pain in 11, and lead related or debulking in 25. Complete removal was achieved in 139 of 145 leads (14 ICD, 131 pacemaker). Partial removal (<4 cm retained) was achieved in five leads (4%), and one lead could not be extracted. Complete success was 95% in the first third of patients, 94% in the second third, and 100% in the latter third. Fluoroscopy time fell from 19 +/- 22 minute in the first third of patients to 11 +/- 8 minute in the second third to 8 +/- 4 minute in the latter third (ANOVA P = 0.02). No major complications occurred. Local bleeding required minor left subclavian vein repair in two individuals. Symptomatic venous thrombosis occurred in 3 of the first 11 cases 1-21 days after extraction, but did not occur in the next 64 consecutive patients who received a 1-month anticoagulation regimen (27% vs 0%, P < 0.001). One patient developed venous thrombosis 3 weeks following cessation of warfarin therapy. Practice guidelines reasonably recommend appropriate training prior to independent performance of lead extraction. The current study suggests that experienced device implanters with appropriate operative backup taking a limited, but intensive training program can be safe and effective at lead extraction in a short time, in part a reflection of the improved technology.

“…Previous studies have addressed the issue of NTL extraction 11–14 , 19–22 . Costa et al 15 recently described their experience using LASER for extraction of 56 relatively long‐standing pacemaker and NTLs (mean implantation time 7.5 years), 9 of which were ICD leads. Clinical success was obtained in 96% of cases and complete lead extraction was possible in 82%.…”

Section: Discussionmentioning

confidence: 99%

“…The use of LASER sheaths produces a controlled ablation of the fibrous tissue attachments to the vascular structures, a more predictable time course and quicker lead removal, and fewer partially removed leads. Recently published experience with LASER sheath‐assisted extraction of pacemaker leads and NTLs 10–15 documented safety and efficacy of such devices. When there is excessive fibrosis or calcification, particularly between the clavicle and the first rib, use of specially designed metal sheaths are used to cut through the scar tissue.…”

Section: Methodsmentioning

confidence: 99%

Nonthoracotomy Implantable Defibrillator Lead Extraction:

Saad

Saliba

Schweikert

et al. 2003

Extraction of pacemaker leads has been demonstrated to be successful and safe in experienced hands using current tools. Whether application of such techniques and tools yield similar results among patients undergoing extraction of nonthoracotomy implantable defibrillator leads is unknown. This report describes a retrospective analysis of indications, techniques used, and outcome of patients who had a single ventricular nonthoracotomy implantable defibrillator lead extracted at The Cleveland Clinic Foundation. Results were compared to a matched population of patients undergoing extraction of ventricular pacemaker leads from a national registry and to the experience with pacemaker lead extraction at The Cleveland Clinic Foundation. Successful complete extraction of ventricular nonthoracotomy implantable defibrillator leads, in the absence of major complications, was achieved in 96.9% of attempts to extract leads from 161 patients. Clinical success was achieved in 98.1% of patients. Failure occurred in three patients. Two patients had major complications, including one death. The most common indication for extraction was infection (46.6%), followed by lead failure (34.2%). Procedure (140.8 vs 171.2 minutes, P<0.01) and fluoroscopy (9.9 vs 11.0 minutes, P<0.01) times compared favorably with those obtained from the pacemaker lead extraction database. Use of LASER did not influence the safety of the procedure or fluoroscopy times. Extraction of ventricular nonthoracotomy implantable defibrillator leads using currently available tools is a complex but effective procedure. In experienced hands, excellent success rates should be achieved with a low incidence of complications.