INITIAL EXPERIENCE WITH A LASER SHEATH TO EXTRACT CHRONIC TRANSVENOUSIMPLANTABLE CARDIOVERTER-DEFIBRILLATOR LEADS

The introduction of transvenous implantable cardiovertor-defibrillator (ICD) therapy has been a major advancement in the prevention of sudde n cardiac death.(1) The reports of recently completed trials has led t o expanded indications for, and most likely expanded usage of, ICD the rapy.(2,3) Despite the relative ease of implantation and the impressiv e efficacy, ICD therapy is not without complications. Lead dislodgment and fracture as well as infection remain not uncommon problems.(4) In addition, ICD leads are significantly larger than traditional pacemak er leads, making lead abandonment more problematic. Given these: issue s, and the expanding usage of ICD therapy, physicians will be faced mo re often with the difficult challenge of ICD lead extraction. Permanen t pacemaker leads often become encapsulated in dense scar tissue makin g ex; traction difficult. Recently, the use of a laser sheath has been shown to be significantly more effective than traditional methods to remove chronic transvenous pacemaker leads.(5) In this report we prese nt our initial experience with the use of a laser sheath to extract ch ronic transvenous ICD leads.