title: Initial experience using Excimer laser for the extraction of chronically implanted pacemaker and implantable cardioverter defibrillator leads in Japanese patients.
abstract: BACKGROUND
  Given the exponential growth in cardiac device implantations, the need for less invasive lead extraction is increasing. The Excimer laser was approved for lead removal in Japan in 2010. The present study reports the initial experience using this novel technique to extract chronically implanted pacemaker and implantable cardioverter defibrillator (ICD) leads from Japanese patients.
  
  
  RESULTS
  We performed a retrospective study of consecutive patients undergoing lead extraction using the laser sheath at a single Japanese center. Patient and lead characteristics, indications, and outcomes were analyzed. From August 2010 to September 2012, a total of 70 leads, including 14 ICD leads, were removed using the laser sheath from 40 patients (26 male, 14 female; age 65.5±18.3 [mean±SD] years; body mass index 21.8±3.5 kg/m2). The median implant duration was 87 months (range 13-328 months). Indications were infection (n=35), venous occlusion (n=4), and pain (n=1). The femoral approach was used in combination with the laser technique in five cases. Complete procedural success was achieved with 68 leads (97.1%). Although the electrode tip was left behind in the remaining two leads, the desired clinical outcomes could be achieved; which were defined as clinical success. No cases resulted in failure. There were no major complications, including death and bleeding requiring open-chest surgery.
  
  
  CONCLUSIONS
  Laser sheaths appear to provide a feasible and effective means of extracting chronically implanted pacemaker and ICD leads in Japanese patients.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: hokamura@hsp.ncvc.go.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Okamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sato
authors.forename: Koji
authors.initials: K
authors.lastname: Ogawa
authors.forename: Ikutaro
authors.initials: I
authors.lastname: Nakajima
authors.forename: Takashi
authors.initials: T
authors.lastname: Noda
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimahara
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hayashi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Onishi
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Shiro
authors.initials: S
authors.lastname: Kamakura
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015992:Body Mass Index; D017147:Defibrillators, Implantable / Q000009:adverse effects; D020878:Device Removal / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Defibrillator; Infectious disease; Laser; Lead extraction; Pacemaker