Pathway To A Successful Laser Lead Extraction Program: Lessons Learned
Lisardo Garcia1, Niberto L. Moreno2.
1Baptist Health of South Florida/Florida International University, Miami, FL, USA, 2Baptist Health of South Florida, Miami, FL, USA.
Objective: The last two decades have witness a decline in cardiac surgical procedures. Cardiovascular implantable electronic devices (CIED) are widely used. Continued population growth and expanding indications have resulted in a progressive increase in the number of CIED implantations. Mirroring this growth, an increasing number of leads require removal because of a variety of indications. Indications for removal are under recognized. Our program had been offering this procedure sporadically. In 2015 we implemented some strategies to capture more patients and to increase the safety of the procedure.
Methods: We reviewed our experience from January 2013 until mid-December 2016 including yearly case volume, major complications, and indication for removal. We established safety protocols based on extraction risk stratification. Extraction risk stratification included age of the leads, type of lead, comorbidities such as renal insufficiency and location of the leads based on non-contrast computed tomography of the chest. In 2015 we assembled a multidisciplinary “Extraction Team” including cardiac surgery, cardiac electrophysiology, and Interventional radiology. We gave informal talks on indications for lead extraction, targeting emergency medicine physicians and hospitalists.
Results: Our lead extraction volume remained constant over the first three years. Strategy implementation in 2015 had a dramatic impact in the volume of cases performed by our team.
The most common indication for extraction was infection. On average, each patient had two leads extracted. Our major complication rate was 4.2% including two deaths secondary to innominate and superior vena cava laceration.
Conclusion: A team approach is fundamental in the building of a successful lead extraction service. Raising awareness of the indications for extraction among primary care physicians is essential and proved to increase our referral volume. Risk stratification is paramount and will require to be validated to increase the safety of the procedure. In times where the traditional cardiac surgical procedures are declining there is opportunity to capture this patient population
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