Extraction of old pacemaker or cardioverter-defibrillator leads by laser sheath versus femoral approach.
BACKGROUND
Some operators routinely extract chronically implanted transvenous leads from a femoral, whereas others prefer a superior approach. This prospective study compared the safety and effectiveness of laser sheaths versus femoral snare extractions.


RESULTS
The single-center study comprised 101 patients referred for unequivocal indications to extract > or =1 transvenous lead(s). Patients were >4 years of age and were randomly assigned to extractions with a laser sheath (group 1: n=50) versus a snare via femoral approach (group 2: n=51). The multicenter study comprised 358 patients who underwent extraction of old transvenous leads using laser sheaths (n=218, group 3) in 3 centers and from a femoral approach (n=138, group 4) in 3 other centers. In the single-center study, the success and complications rates were similar in groups 1 and 2. No patient died of a periprocedural complication. The procedural duration (51+/-22 versus 86+/-51 minutes) and duration of total fluoroscopic exposure (7+/-7 versus 21+/-17 minutes) were significantly shorter (each P<0.01) in group I than in group 2. In the multicenter study, we observed 2 procedure-associated deaths in group 3 versus 1 in group 4. Major procedural complications were observed in 3% of patients in group 3, versus 3% in group 4 (P=NS). The rates of complete, partial, and unsuccessful extractions were similar in groups 3 and 4.


CONCLUSIONS
Old transvenous leads were extracted with similar success and complication rates by the femoral and laser approaches. However, the femoral approach was associated with longer procedures and a longer duration of fluoroscopic exposure.
Bordachar
Pierre
P
Hospital Du Haut-Leveque, Service Pr Clementy, Pessac, France. bordacharp@hotmail.com
Defaye
Pascal
P
Peyrouse
Eric
E
Boveda
Serge
S
Mokrani
Bilel
B
Marquié
Christelle
C
Barandon
Laurent
L
Fossaert
Emilie Marcant
EM
Garrigue
Stephane
S
Reuter
Sylvain
S
Laborderie
Julien
J
Marijon
Eloi
E
Deharo
Jean-Claude
JC
Jacon
Peggy
P
Kacet
Salem
S
Ploux
Sylvain
S
Deplagne
Antoine
A
Haissaguerre
Michel
M
Clementy
Jacques
J
Ritter
Philippe
P
Klug
Didier
D
D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005471:Fluoroscopy; D005602:France; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D011829:Radiation Dosage; D015641:Radiography, Interventional; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome