Europace Advance Access originally published online on June 27, 2007
Europace 2007 9(8):651-656; doi:10.1093/europace/eum098
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PACING AND LEAD EXTRACTION
Laser-assisted lead extraction: the European experience
1 Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden;
2 St. Thoma
Hospital, London, UK;
3 Universitätsklinikum Rudolf Virchow, Berlin, Germany;
4 Broadgreen Hospital, Liverpool, UK;
5 Universitätkliniek Inselspital, Bern, Switzerland;
6 Thoraxcenter, Rotterdam, The Netherlands;
7 UZ Hospital, Gent, Belgium;
8 Santa Cruz Hospital, Carnaxide, Portugal;
9 Skejby Hospital, Aarhus, Denmark;
10 St Georges Hospital, London, UK;
11 Stadt Nürnberg Klinikum, Nürnberg, Germany;
12 Kerkhoff Klinik, Bad Nauheim, Germany;
13 Onze Lieve Vrouwziekenhuis, Aalst, Belgium
Aims The aim of this study is to investigate the safety and effectiveness of Excimer laser-assisted lead extraction in Europe. The final European multi-centre study experience is presented.
Method and results The Excimer is a cool cutting laser (50°C) with a wavelength of 308 nm. The energy is emitted from the tip of a flexible sheath and is absorbed by proteins and lipids, 64% of the energy is absorbed at a tissue depth of 0.06 mm. The sheath is positioned over the lead, and the fibrosis surrounding the lead is vaporized while advancing the sheath without damaging other leads. From August 1996 to March 2001, 383 leads (170 atrial, 213 ventricular) in 292 patients (mean age 61.6 years, range 13–96) were extracted at 14 European centres. Mean implantation time was 74 months (3–358). Most frequent indications were pocket infection (26%), non-functional leads (21%), patient morbidity (21%), septicaemia or endocarditis (14%), erosion (5%), and lead interference (8%). Median extraction time was 15 min (1–300). Complete extraction was achieved in 90.9% of the leads and partial extraction in 3.4%. Extraction failed in 5.7% of the leads. Major complications = perforations caused 10/22 (3.4/5.7%) of the failures. Most partially extracted patients were considered clinically successful, as only minor lead parts without clinical significance were left. Femoral non-laser technique was used to remove 8/12 of the non-complication failures. The total complication rate, including five minor complications (1.7%), was 5.1%. No in-hospital mortality occurred.
Conclusion Pacing and implantable cardioverter–defibrillator leads can safely, effectively, and predictably be extracted. Open-heart extractions can be limited to special cases. The results indicate that the traditional policy of abandoning redundant leads, instead of removing them, may be obsolete in many patients.
Key Words: Extraction, Excimer, Laser Pacemaker leads, ICD leads, Ultraviolet
* Corresponding author. Tel: +46 31 342 1000; fax: +46 31 417991. E-mail address: charles.kennergren{at}vgregion.se
Manuscript submitted 17 December 2003. Accepted after revision 19 April 2007.
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