title: Laser lead extraction in adult congenital heart disease.
abstract: BACKGROUND
  In adults with congenital heart disease (ACHD), lead extraction procedures are expected to parallel increasing transvenous pacemaker and defibrillator implantations. We sought to assess the safety and feasibility of laser lead extraction in ACHD.
  
  
  RESULTS
  All laser lead extractions (Spectranectics, Colorado Springs, CO, USA) performed at the Montreal Heart Institute between September 2000 and August 2005 were prospectively registered. Efficacy and complications in patients with ACHD were compared to the larger cohort. Laser lead extraction was attempted on 270 leads in 175 patients. In ACHD, 23 (five atrial, 15 ventricular pacing, and three defibrillator) leads were targeted in 16 patients. Indications were: infection 44%, dysfunction 25%, upgrade 25%, and pain 6%. Patients with ACHD were younger (43.0 +/- 13.5 vs 63.7 +/- 14.7 years, P < 0.0001) and had a higher proportion of active fixation leads (74% vs 37%, P = 0.0013). Lead age in patients with and without ACHD was 9.0 +/- 5.2 vs 7.7 +/- 5.2 years (P = 0.2713). Overall, 21 of 23 leads (91%) were successfully extracted in ACHD compared with 220 of 247 leads (89%) (P = 0.7405). One major complication (6.3%) occurred in ACHD (tricuspid valve laceration) compared with five major (3.0%) and eight minor (5.0%) complications in patients without ACHD. Presence of ACHD did not modulate procedural success (OR 1.3, 95% CI [0.3, 5.8]) or complications (OR 1.0, 95% CI [0.2, 4.4]). Median procedural time was 27 minutes longer in ACHD (127 vs 100 minutes, P = 0.0595).
  
  
  CONCLUSIONS
  In selected patients with ACHD, laser lead extraction may be performed with a safety and efficacy profile comparable to patients without ACHD.
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, Montreal, QC, Canada. paul.khairy@umontreal.ca
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Roux
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.forename: Lise-Andrée
authors.initials: LA
authors.lastname: Mercier
authors.forename: Annie
authors.initials: A
authors.lastname: Dore
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Pierre
authors.initials: P
authors.lastname: Pagé
mesh_terms: D000328:Adult; D015897:Comorbidity; D020878:Device Removal / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000295:instrumentation / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D053685:Laser Therapy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000453:epidemiology*; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D010146:Pain / Q000453:epidemiology*; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome