title: Extraction of chronic pacemaker and defibrillator leads from the coronary sinus: laser infrequently used but required.
abstract: 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.
authors.affiliation: St Thomas' Hospital, London, UK. shoaibhamid@hotmail.com
authors.forename: Shoaib
authors.initials: S
authors.lastname: Hamid
authors.forename: Aruna
authors.initials: A
authors.lastname: Arujuna
authors.forename: Aruna
authors.initials: A
authors.lastname: Arujna
authors.forename: Sitara
authors.initials: S
authors.lastname: Khan
authors.forename: Andrew
authors.initials: A
authors.lastname: Ladwiniec
authors.forename: Mark
authors.initials: M
authors.lastname: McPhail
authors.forename: Julian
authors.initials: J
authors.lastname: Bostock
authors.forename: Margaret
authors.initials: M
authors.lastname: Mobb
authors.forename: Nik
authors.initials: N
authors.lastname: Patel
authors.forename: Cliff
authors.initials: C
authors.lastname: Bucknall
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: 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