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 <25 kg/m2 and low extraction volume centers. Procedural failure was higher in leads implanted for >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 <25 kg/m2. Overall all-cause in-hospital mortality was 1.86%; 4.3% when associated with endocarditis, 7.9% when associated with endocarditis and diabetes, and 12.4% when associated with endocarditis and creatinine ≥2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine ≥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/m2. Centers with smaller case volumes tended to have a lower rate of successful extraction.
Recommended CitationWazni, MD, Oussama; Epstein, MD, Laurence M.; Carrillo, MD, Roger G.; Love, MD, Charles; Adler, MD, Stuart W.; Riggio, MD, David W.; Karim, MD, Shahzad S.; Bashir, MD, Jamil; Greenspon, MD, Arnold J.; DiMarco, MD, PhD, John P.; Cooper, MD, Joshua M.; Onufer, MD, John R.; Ellenbogen, MD, Kenneth A.; Kutalek, MD, Stephen P.; Dentry-Mabry, MSN, Sherri; Ervin, PhD, Carolyn M.; and Wilkoff, MD, Bruce L., "Lead Extraction in the Contemporary Setting: The LExICon Study. An Observational Retrospective Study of Consecutive Laser Lead Extractions" (2010). Division of Cardiology Faculty Papers. Paper 8.