Excimer laser for pacemaker and defibrillator lead extraction: Techniques and clinical results

Pacing and defibrillation leads may need to be removed for several reasons including infection, interference with others leads, lack of vascular acces s or redundancy. However, the removal of chronically implanted leads is a m ajor technical challenge because of the extensive adhesions that develop al ong the course of the leads over time. The techniques to remove chronic lea ds have been greatly facilitated by the development of an excimer laser she ath. We undertook an analysis of our experience with laser extraction in th e first 50 leads attempted. An excimer laser sheath system, developed by th e Spectranetics Corporation, was used to extract 50 chronically implanted l eads in 34 patients. The mean patient age was 64 +/- 12 years, all were mal e and the average duration that the leads had been implanted was 5.0 +/- 3. 9 years, Two-thirds of the leads were pacemaker and one-third were defibril lator leads. There was a 100% clinical success rate and 48 of the 50 leads were completely removed. There were no major complications. There was one m inor complication of subclavian vein thrombosis and two haemodynamically no n-significant episodes of air embolism. The main limitation observed was fa ilure of the excimer laser sheath to advance in 18% of cases, probably due to the presence of calcified adherences on leads. Two strategies were found useful to deal with this problem: under the clavicle stainless-steel sheat hs were used to break up calcified adherences and within the venous system the laser sheath was upsized in order to advance over the calcification on the lead. It was concluded that excimer laser has greatly facilitated the r emoval of chronically implanted pacemaker and defibrillator leads. There is a high success rate and low complication rate in our experience. The main limitation of laser is the presence of calcified adherences.