Minimally-invasive Laser Lead Extraction Comparison Of Infected Vs. Non-infected Leads
Simon Pecha, Nils Gosau, Stephan Willems, Hermann Reichenspurner, Samer Hakmi.
University Heart Center Hamburg, Hamburg, Germany.
OBJECTIVE: We investigated the effect of systemic infection or lead endocarditis on the difficulty and success of laser lead extraction (LLE) procedures.
METHODS: Medical records of all patients undergoing LLE between January 2012 and August 2015 were screened with regard to sufficient information on systemic infection or lead endocarditis. We treated 101 patients using high frequency 80 Hz laser sheaths in patients with lead implant duration of ≥24 months. Indications for lead extraction were; systemic infection and lead endocarditis 29.7%, local infection 49.5%, lead dysfunction 15.8%, upgrades 3.0% and tricuspid insufficiency 2.0%. 239 leads were scheduled for LLE: 175 pacing and 64 ICD leads; mean time from initial lead implantation 96.5 ± 65.5 months (range 24-408). The patient lead distribution with regard to systemic infection or lead endocarditis: Systemic infection and lead endocarditis (Group A): 30 patients, 78 leads; local infection and other extraction indications (Group B): 71 patients, 161 leads.
RESULTS: Complete procedural success was significantly higher in group A than in group B (100% vs. 94.4%; p=0.0331). The laser treatment time and fluoroscopy time were numerically lower in group A. Mean time from initial lead implantation (103.4 vs. 89.6 months; p= 0.1320) and ratio of ICD leads (28.2% vs. 26.1%; p=0.7566) did not differ significantly between the two groups. Minor and major complications were low in both groups and did not reveal any significant difference (Group A: one minor complication; pocket hematoma, group B: two major complications; pericardial effusion and emergent sternotomy due to SVC perforation). No extraction related mortality was observed.
CONCLUSIONS: The presence of systemic infection or lead endocarditis in LLE procedures allows for higher complete procedural success. When compared with LLE of non-infected leads, the infected leads require less laser and fluoroscopy times. Due to the scarcity of minor and major complications, no statistical significance was found in that regard.
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