The learning curve characteristics of lead extraction with a laser she
ath were examined in 19 patients. Forty-two leads were removed: five l
eads were removed by traction alone, five required a femoral approach
as a primary procedure and a laser sheath was used in 32 lead extracti
on attempts. Primary laser success was achieved in 26 attempts (81%).
A femoral approach was successfully applied as a back-up procedure in
five of the failures. Overall, 26% of the leads were removed by the fe
moral approach. The overall success rate was 98% (41 of 42 leads). No
variables related to the patients, leads, or extraction techniques wer
e significantly related to failure of laser sheath extraction. There w
as a distinct learning curve with all but one failure occurring in the
first half of our cases. All failures occurred with leads implanted f
rom the right subclavian vein. In four, a sharply angled curve at the
subclavian vein-superior vena cava junction could not be passed with t
he laser sheath. The ability to smooth this curve improved the results
during the learning curve. All procedures were performed in the opera
ting room for safety reasons. This precaution was lifesaving in a case
of acute tamponade after laser extraction of an atrial lead. In anoth
er case the left internal mammary artery was torn after laser sheath e
xtraction, causing the formation of a false aneurysm. New pacing leads
were introduced in nine patients during the same procedure. The mean
procedure time was 255 +/- 110 min, reflecting the complexity of these
procedures.