Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions.
OBJECTIVE
This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients.


BACKGROUND
The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices.


METHODS
Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included.


RESULTS
Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the time, with a 97.7% clinical success rate whereby clinical goals associated with the indication for lead removal were achieved. Failure to achieve clinical success was associated with body mass index <25 kg/m(2) and low extraction volume centers. Procedural failure was higher in leads implanted for >10 years and when performed in low volume centers. Major adverse events in 20 patients were directly related to the procedure (1.4%) including 4 deaths (0.28%). Major adverse effects were associated with patients with a body mass index <25 kg/m(2). Overall all-cause in-hospital mortality was 1.86%; 4.3% when associated with endocarditis, 7.9% when associated with endocarditis and diabetes, and 12.4% when associated with endocarditis and creatinine > or =2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine > or =2.0.


CONCLUSIONS
Lead extraction employing laser sheaths is highly successful with a low procedural complication rate. Total mortality is substantially increased with pocket infections or device-related endocarditis, particularly in the setting of diabetes, renal insufficiency, or body mass index <25 kg/m(2). Centers with smaller case volumes tended to have a lower rate of successful extraction.
Wazni
Oussama
O
Department of Cardiovascular Disease, Cleveland Clinic, Cleveland, Ohio 44195, USA. waznio@ccf.org
Epstein
Laurence M
LM
Carrillo
Roger G
RG
Love
Charles
C
Adler
Stuart W
SW
Riggio
David W
DW
Karim
Shahzad S
SS
Bashir
Jamil
J
Greenspon
Arnold J
AJ
DiMarco
John P
JP
Cooper
Joshua M
JM
Onufer
John R
JR
Ellenbogen
Kenneth A
KA
Kutalek
Stephen P
SP
Dentry-Mabry
Sherri
S
Ervin
Carolyn M
CM
Wilkoff
Bruce L
BL
D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors