title: Lead extraction with high frequency laser sheaths: a single-centre experience.
abstract: OBJECTIVE
  Extraction of chronically implanted cardiac implantable electrophysiological devices leads can be difficult. Excimer laser-assisted extraction with 40 Hz sheaths has shown good results in challenging cases. In 2012, a new 80 Hz high-frequency laser sheath became available that delivers twice as many pulses per second. Here, we report our clinical experience with the new GlideLight 80 Hz laser sheath.
  
  
  METHODS
  Between January 2012 and August 2016, 292 leads were treated in 151 patients using 80 Hz GlideLight laser sheath. Lead extraction indications included systemic infection or lead endocarditis n =  35 (23.2%), local infection n =  73 (48.3%), lead dysfunction n =  32 (21.2%), system upgrade n =  5 (3.3%), tricuspid regurgitation n =  3 (2.0%) and other indications n =  3 (2.0). All patient-related and procedural data were collected into a database and analysed.
  
  
  RESULTS
  Mean patient's age was 66.2 ± 14.4 years, 73.5% were male. Ninety-one (31.2%) atrial, 159 (54.4%) ventricular and 42 (14.4%) coronary sinus leads had to be extracted. The mean time from initial lead implantation was 98.0 ± 65.2 months. Mean laser treatment time was 67.5 ± 71.3 s, mean laser pulses delivered were 5130 ± 6592. Clinical success was achieved in 99.3% of the cases, while complete procedural success was observed in 96.7%. A failure of extraction was seen in 2 (1.3%) patients. An overall complication rate of 2.0%, including two major (1.3%) and one minor (0.7%) complications, was observed. No periprocedural mortality was seen.
  
  
  CONCLUSIONS
  The new GlideLight high-frequency laser sheath allows for a high safety and efficacy in extraction of chronically implanted pacemaker- and implantable cardioverter-defibrillator leads.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Pecha
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Linder
authors.affiliation: Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Gosau
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Liesa
authors.initials: L
authors.lastname: Castro
authors.affiliation: Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Vogler
authors.affiliation: Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Samer
authors.initials: S
authors.lastname: Hakmi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: High frequency laser sheaths; ICD lead extraction; Laser lead extraction; Pacemaker lead extraction