Differences in laser lead extraction of infected vs. non-infected leads
- 17 Downloads
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.
KeywordsLaser lead extraction Lead endocarditis CIED infections Pacemaker infection
Compliance with ethical standards
Conflict of interest
Samer Hakmi is a Proctor of Spectranetics Corp.
- 1.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):i1–75CrossRefPubMedGoogle Scholar
- 6.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):1007–1014CrossRefPubMedGoogle Scholar
- 7.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 121:458–477CrossRefPubMedGoogle Scholar
- 8.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–e551CrossRefPubMedGoogle Scholar
- 10.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 18:56–60CrossRefPubMedGoogle Scholar
- 11.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 24:77–81CrossRefPubMedGoogle Scholar
- 13.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 55:579–586CrossRefGoogle Scholar
- 21.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 22:1348–1357CrossRefPubMedGoogle Scholar