Arrhythmia device lead extraction: factors that necessitate laser assistance.
BACKGROUND
The removal of pacemaker and implantable cardioverter defibrillator (ICD) leads has become a common procedure. The need for laser use has considerable implications regarding cost and expertise. It is not an option at all centres and introduces an element of risk to the procedure. Anticipation of the need for laser assistance may be of benefit to procedure planning.


METHODS
Data on all patients undergoing lead extraction at London Health Sciences Centre (London, Ontario) between July 2001 and October 2006 were reviewed. Variables were assessed for independent association with the need for laser assistance. A prediction rule for laser use was created based on the multivariate model.


RESULTS
From July 2001 to October 2006, 154 patients underwent lead extraction, with laser assistance required in 106 patients (68.8%). One hundred seven patients (69.5%) had pacemakers and the remainder had ICDs. The mean (+/- SD) device age was 7.6+/-5.7 years, with 1.9+/-0.9 leads requiring extraction. Clinical success was achieved in 152 patients (98.7%). Multivariate analysis revealed that laser use was less likely among men (OR 0.24, 95% CI 0.069 to 0.84; P=0.026) and among septic patients (OR 0.25, 95% CI 0.072 to 0.84; P=0.025), and more likely with ICDs than pacemakers (OR 4.40, 95% CI 1.50 to 12.91; P=0.0069) and with each additional year of device age (OR 1.46 per year, 95% CI 1.26 to 1.70; P<0.0001).


CONCLUSIONS
Laser assistance was required in 68.8% of cases, with clinical success in 98.7% of patients. Laser use was less likely among septic patients and men, and more likely with ICD leads and increasing time since lead implant. It was not possible to derive an accurate prediction rule for cases that would not need laser assistance. Therefore, it is prudent to ensure that a laser and appropriate infrastructure is available for lead extractions, and that the patient is aware of the possible need for laser assistance, along with the risks entailed.
Department of Medicine, University of Western Ontario, London, Canada.
Lorne J
LJ
Gula
Andrew D
AD
Krahn
Raymond
R
Yee
Allan C
AC
Skanes
Nina
N
Ghosh
George J
GJ
Klein
D001145:Arrhythmias, Cardiac / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D007834:Lasers; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome