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Minimally invasive lead extraction is safe and effective even in patients with large intracardiac Vegetations ≥ 20 mm
Samer Hakmi, Simon Pecha, Hermann Reichenspurner, Hendrik Treede.
University Heart Center Hamburg, Hamburg, Germany.

OBJECTIVE: In recent years, pacemaker (PM) and implantable cardioverter-defibrillator (ICD) insertion has increased. Lead infection or vegetation formation is one of the major complications of these devices. Complete device and lead removal is recommended for all patients with local or systemic infection (Class I). Management of patients with large lead vegetations ≥ 20 mm is still in debate. Historically, they were treated with open surgical lead removal. We here present our 10-years’ experience in laser lead extraction of PM and ICD leads as a routine approach in patients with large intracardiac vegetations.
METHODS: Between August 2004 and July 2014, 213 patients at our centre underwent laser lead extraction due to infection. Local and- systemic infection occurred in 144 and 69 patients respectively. Data were prospectively collected and retrospectively analysed.
RESULTS: A total of 38 patients had intracardiac vegetations identified by echocardiography. Thirteen patients were determined to have lead vegetation > 20 mm. Mean patients’ age was 66.1 ±11.7 years, and 73.7% were male. The mean time from initial lead implantation was 91.3±60.0 months (range 28-288). 74 of 78 leads were completely extracted. Mean time of hospitalization was 35.1±7.4 days (range 26-51). Mean follow-up time was 236.3±56.6 days (range 113-402), showing survival rate of 94.7%. No patient experienced clinically evident pulmonary embolism requiring further interventions. One patient had severe tricuspid regurgitation. No death was directly related to the extraction procedure.
CONCLUSIONS: Laser extraction is a safe and highly effective procedure for infected PM and ICD leads, even in patients with large intracardiac vegetations. However, silent pulmonary embolism cannot be denied. Furthermore, only patients with unsuccessful laser extraction should undergo open surgical lead removal.

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