Lead extraction experience with high frequency excimer laser.
BACKGROUND
A higher frequency Excimer laser sheath using an 80-Hz pulse repetitive rate was approved by the Food and Drug Administration in April 2012. We reported our initial clinical experience with a high-frequency Excimer laser sheath and compared it with lower-frequency laser sheaths which have been previously used.


METHODS
In this single center, retrospective cohort study, we evaluated patients who underwent lead extraction from December 2008 to May 2013. Those who underwent lead removal without using a laser sheath or with approaches other than subclavian were excluded. Primary endpoints included total laser time, number of pulses, and complications. Data on clinical characteristics, lead type, indications, and outcomes were prospectively collected and analyzed.


RESULTS
A total of 427 patients were included in the study (72.6% male; age 67.9 ± 15.23 years). Lower frequency and higher frequency laser sheaths were used in 315 and 112 patients, respectively. A total of 821 leads were removed with 765 leads (93.2%) extracted using the Excimer laser sheath. Lead age was 5.71 ± 4.96 years. Complete extraction was seen in all patients. A higher-frequency laser sheath was associated with a lower laser time and a lower total number of laser pulses even after adjustments for the number of leads, type of leads, and lead age. In the higher frequency group, mortality rate was 0.9% and minor complication rate was 3.6%.


CONCLUSIONS
When compared with the lower-frequency laser sheath, the higher-frequency laser sheath requires less laser times and more efficient amount of pulses for lead extraction with comparable success rate. Due to the rarity of major and minor complications, no statistical significance was found between the two groups.
Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Tanyanan
T
Tanawuttiwat
Daniel
D
Gallego
Roger G
RG
Carrillo
D000368:Aged; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome
cardiac implantable electronic devices; complications; device infection; laser Excimer sheath; transvenous lead extraction