Abstract
We investigated the effect of systemic infection or lead endocarditis on the complexity and the success of laser lead extraction (LLE) procedures. Medical records of all patients undergoing LLE between January 2012 and March 2017 were screened with regard to information on systemic infection or lead endocarditis. We treated 184 patients using high-frequency 80 Hz laser sheaths in patients with lead implant duration of ≥ 12 months. Indications for lead extraction were systemic infection and lead endocarditis in 52 cases (28.3%), local infection in 74 cases (40.2%), lead dysfunction in 37 cases (20.1%) and other indications in 21 cases (11.4%). 386 leads were scheduled for LLE: 235 (60.9%) pacing, 105 (27.2%) ICD and 46 (11.9%) CS leads. The mean time from initial lead implantation (systemic infection 96.8 ± 74.7 months vs. 102.1 ± 82.6 non-infected: months; p = 0.4155) and ratio of ICD leads (26.8 vs. 27.4%; p = 0.3411) did not differ significantly between the two groups. Complete procedural success was significantly higher in the systemic infection group (100 vs. 94.7%; p = 0.0077). The mean laser treatment (60.2 ± 48.7 vs. 72.4 ± 61.5 s; p = 0.2038) was numerically lower in the infection group, while fluoroscopy time (9.3 ± 7.6 vs. 12.8 ± 10.3 min; p = 0.0275) was significantly lower in this group. Minor and major complications were low in both groups and did not reveal any statistically significant difference (infected group: one minor complication; pocket hematoma, non-infected: three major complications; emergent sternotomy due to pericardial tamponade). No extraction related mortality was observed. The presence of systemic infection or lead endocarditis in LLE procedures allows for higher complete procedural success. When compared with LLE of non-infected leads, the infected leads require less laser and fluoroscopy times. Due to the scarcity of minor and major complications in general, no statistical significance was found in that regard.
Similar content being viewed by others
References
Raatikainen MJ, Arnar DO, Zeppenfeld K, Merino JL, Levya F, Hindriks G, Kuck KH (2015) Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace 17(Suppl 1):i1–75
Birnie D, Williams K, Guo A, Mielniczuk L, Davis D, Lemery R, Green M, Gollob M, Tang A (2006) Reasons for escalating pacemaker implants. Am J Cardiol 98:93–97
Catanchin A, Murdock CJ, Athan E (2007) Pacemaker infections: a 10-year experience. Heart Lung Circ 16:434–439
Voigt A, Shalaby A, Saba S (2010) Continued rise in rates of cardiovascular implantable electronic device infections in the United States: temporal trends and causative insights. Pacing Clin Electrophysiol 33:414–419
Tischer TS, Hollstein A, Voss W, Wendig I, Lauschke J, Schneider R, von Knorre GH, Bänsch D (2014) A historical perspective of pacemaker infections: 40-years single-centre experience. Europace 16:235–240
Ozcan C, Raunso J, Lamberts M, Kober L, Lindhardt TB, Bruun NE, Laursen ML, Torp-Pedersen C, Gislason GH, Hansen ML (2017) Infective endocarditis and risk of death after cardiac implantable electronic device implantation: a nationwide cohort study. Europace 19(6):1007–1014
Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, Bolger AF, Estes NA 3rd, Gewitz M, Newburger JW, Schron EB, Taubert KA (2010) Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 121:458–477
Kusumoto FM, Schoenfeld MH, Wilkoff BL, Berul CI, Birgersdotter-Green UM, Carrillo R, Cha YM, Clancy J, Deharo JC, Ellenbogen KA, Exner D, Hussein AA, Kennergren C, Krahn A, Lee R, Love CJ, Madden RA, Mazzetti HA, Moore JC, Parsonnet J, Patton KK, Rozner MA, Selzman KA, Shoda M, Srivathsan K, Strathmore NF, Swerdlow CD, Tompkins C, Wazni O (2017) HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 14(12):e503–e551
Tarakji KG, Chan EJ, Cantillon DJ, Doonan AL, Hu T, Schmitt S, Fraser TG, Kim A, Gordon SM, Wilkoff BL (2010) Cardiac implantable electronic device infections: presentation, management, and patient outcomes. Heart Rhythm 7:1043–1047
Hakmi S, Pecha S, Sill B, Reiter B, Willems S, Aydin MA, Yildirim Y, Reichenspurner H, Treede H (2014) Initial experience of pacemaker and implantable cardioverter defibrillator lead extraction with the new GlideLight 80 Hz laser sheaths. Interact Cardiovasc Thorac Surg 18:56–60
Pecha S, Yildirim Y, Gosau N, Aydin MA, Willems S, Treede H, Reichenspurner H, Hakmi S (2017) Laser lead extraction allows for safe and effective removal of single- and dual-coil implantable cardioverter defibrillator leads: a single-centre experience over 12 years. Interact Cardiovasc Thorac Surg 24:77–81
Pecha S, Castro L, Gosau N, Linder M, Vogler J, Willems S, Treede H, Reichenspurner H, Hakmi S (2017) Evaluation of tricuspid valve regurgitation following laser lead extraction. Eur J Cardiothorac Surg 51:1108–1111
Wazni O, Epstein LM, Carrillo RG, Love C, Adler SW, Riggio DW, Karim SS, Bashir J, Greenspon AJ, DiMarco JP, Cooper JM, Onufer JR, Ellenbogen KA, Kutalek SP, Dentry-Mabry S, Ervin CM, Wilkoff BL (2014) Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions. J Am Coll Cardiol 55:579–586
Tanawuttiwat T, Gallego D, Carrillo RG (2014) Lead extraction experience with high frequency excimer laser. Pacing Clin Electrophysiol 37:1120–1128
Le KY, Sohail MR, Friedman PA, Uslan DZ, Cha SS, Hayes DL, Wilson WR, Steckelberg JM, Baddour LM (2011) Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. Heart Rhythm 8:1678–1685
Viganego F, O’Donoghue S, Eldadah Z, Shah MH, Rastogi M, Mazel JA, Platia EV (2012) Effect of early diagnosis and treatment with percutaneous lead extraction on survival in patients with cardiac device infections. Am J Cardiol 109:1466–1471
Huang XM, Fu H, Osborn MJ, Asirvatham SJ, McLeod CJ, Glickson M, Acker NG, Friedman PA, Cha YM (2015) Extraction of superfluous device leads: a comparison with removal of infected leads. Heart Rhythm 12:1177–1182
Esposito M, Kennergren C, Holmstrom N, Nilsson S, Eckerdal J, Thomsen P (2002) Morphologic and immunohistochemical observations of tissues surrounding retrieved transvenous pacemaker leads. J Biomed Mater Res 63:548–558
Kennergren C, Bjurman C, Wiklund R, Gabel J (2009) A single-centre experience of over one thousand lead extractions. Europace 11:612–617
Bracke F, Meijer A, Van Gelder B (2002) Extraction of pacemaker and implantable cardioverter defibrillator leads: patient and lead characteristics in relation to the requirement of extraction tools. Pacing Clin Electrophysiol 25:1037–1040
Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Turk KT, Reeves R, Young R, Crevey B, Kutalek SP, Freedman R, Friedman R, Trantham J, Watts M, Schutzman J, Oren J, Wilson J, Gold F, Fearnot NE, Van Zandt HJ (1999) Intravascular extraction of problematic or infected permanent pacemaker leads: 1994–1996. U.S. Extraction Database, MED Institute. Pacing Clin Electrophysiol 22:1348–1357
Funding
No funding was received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Samer Hakmi is a Proctor of Spectranetics Corp.
Rights and permissions
About this article
Cite this article
Pecha, S., Castro, L., Vogler, J. et al. Differences in laser lead extraction of infected vs. non-infected leads. Heart Vessels 33, 1245–1250 (2018). https://doi.org/10.1007/s00380-018-1162-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-018-1162-0