Extraction of chronic pacemaker and defibrillator leads from the coronary sinus: laser infrequently used but required.
OBJECTIVE
Cardiac resynchronization therapy is an accepted treatment for heart failure but it may be necessary to explant these systems along with their leads. The evidence base for coronary sinus (CS) lead extractions is limited. We aimed to evaluate the percutaneous removal of these leads and the utility of laser extraction when necessary.


RESULTS
Of 265 patients referred for lead extraction between January 2004 and June 2008, 32 (12.1%) involved CS leads (30 males, mean age 67 years). Mean implantation time was 26.5 +/- 28.7 months (range 1-116 months). Indications for extraction were pocket infection (34.4%), lead malfunction (43.8%), skin erosion (15.6%), and endocarditis (6.2%). Twenty-eight (87.5%) CS leads were removed with manual traction, with laser utilized in four cases (12.5%). No major complications of CS laceration, pericardial effusion, emergency surgery, or death occurred.


CONCLUSIONS
Our experience supports the percutaneous extraction of CS leads as a safe and effective procedure including the utility of laser when necessary.
Hamid
Shoaib
S
St Thomas' Hospital, London, UK. shoaibhamid@hotmail.com
Arujuna
Aruna
A
Arujna
Aruna
A
Khan
Sitara
S
Ladwiniec
Andrew
A
McPhail
Mark
M
Bostock
Julian
J
Mobb
Margaret
M
Patel
Nik
N
Bucknall
Cliff
C
Rinaldi
Christopher A
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D054326:Coronary Sinus / Q000601:surgery*; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000628:therapy; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome