title: Central venous occlusion is not an obstacle to device upgrade with the assistance of laser extraction.
abstract: OBJECTIVE
  To assess the efficacy and safety of laser-assisted lead extraction for upgrade of existing pacemakers and defibrillators in patients with central venous obstruction.
  
  
  BACKGROUND
  Implantable cardiac defibrillators and biventricular pacing have become the accepted therapeutic measures for patients with congestive heart failure. Many patients who are candidates for device therapy, however, already have existing right ventricular leads and the presence of central venous obstruction. Upgrade of existing devices in these patients is a dilemma, which is increasingly encountered by device-implanting physicians. Laser-assisted extraction of existing leads can facilitate access for device upgrade and provide an alternative to lead abandonment and contralateral implant.
  
  
  METHODS
  We review our experience with laser-assisted lead extraction in patients, referred for upgrade of existing devices, who were found to have, or known to have, ipsilateral subclavian vein occlusion.
  
  
  RESULTS
  Over the past 3 years, 18 patients (13 men, 5 women; mean age 63.9 +/- 16 years) with subclavian vein occlusion underwent successful laser-assisted lead extraction (total 29 leads) and upgrade of existing leads to defibrillators and/or biventricular systems. Mean implant duration prior to extraction was 70.8 +/- 43.5 (11-192) months. Cannulation of the coronary sinus and placement of a transvenous left ventricular lead were achieved in all 13 patients in whom it was attempted. No complications occurred.
  
  
  CONCLUSIONS
  Laser-assisted lead extraction is a safe and effective approach, allowing for ipsilateral device upgrade in patients with existing devices and central venous obstruction.
authors: Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors: Lorne J
authors: LJ
authors: Gula
authors: Alyson
authors: A
authors: Ames
authors: Ashley
authors: A
authors: Woodburn
authors: John
authors: J
authors: Matkins
authors: Michael
authors: M
authors: McCormick
authors: Jeffrey
authors: J
authors: Bell
authors: Deborah
authors: D
authors: Sink
authors: James
authors: J
authors: McConville
authors: Laurence M
authors: LM
authors: Epstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D047548:Defibrillators; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013350:Subclavian Vein; D014652:Vascular Diseases / Q000150:complications