title: Laser lead extraction: predictors of success and complications.
abstract: BACKGROUND
  Paralleling the rise in pacemaker and defibrillator implantations, lead extraction procedures are increasingly required. Concerns regarding failure and complications remain.
  
  
  RESULTS
  A total of 200 lead extraction procedures were performed at the Montreal Heart Institute between September 2000 and August 2005. In 23 patients, all leads were removed by traction with a locking stylet. A total of 270 leads were extracted using a laser sheath system (Spectranectics, Colorado Springs, CO, USA) in 177 procedures involving 175 patients (74% male), age 62+/-16 years. Procedural indications were: infection 88 (50%), dysfunction 54 (30%), upgrade 21 (12%), and other 14 (8%). Overall, 241 leads (89%) were successfully extracted, 7 (3%) were partially extracted (< or = 4 cm retained), and 22 (8%) were non-extractable. In multivariate analyses, predictors of failed extraction were longer time from implant (OR 1.16 per year, P=0.0001) and history of hypertension (OR 5.2, P=0.0023). Acute complications occurred in 14 of 177 procedures (7.9%): 8 (4.5%) minor and 6 (3.4%) major, with one death. In multivariate analyses, the only predictor of acute complications was laser lead extraction from both right and left sides during the same procedure (OR 9.4, P = 0.0119). In addition, 3 of 10 patients with failed or partially extracted infected systems eventually required open chest explantation because of endocarditis.
  
  
  CONCLUSIONS
  Most leads not amenable to manual traction may be successfully extracted by a percutaneous laser sheath system. While most complications are minor, major complications including death may occur. Older leads are at higher risk for failed extraction. Endocarditis may ensue if infected leads are incompletely removed.
authors.affiliation: Electrophysiology Service, Department of Cardiology, Montreal Heart Institute, Montreal, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Roux
authors.forename: Pierre
authors.initials: P
authors.lastname: Pagé
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: Denis
authors.initials: D
authors.lastname: Roy
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
mesh_terms: D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D020878:Device Removal / Q000379:methods / Q000401:mortality*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D004696:Endocarditis / Q000401:mortality*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome