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DOI: 10.1055/s-0034-1367433
Laser lead extraction allows for safe and effective removal of single- as well as dual coil ICD leads
Objectives: Laser lead extraction in patients with multiple- or old implantable cardioverter defibrillator (ICD) leads is challenging. Following renewed guidelines the number of implanted ICD/CRT devices has been rising in recent years. In the same way the number of ICD leads that need to be extracted is emerging. Single- as well as dual coil leads are frequently used. As adhesions are very common at the side of the shock coils, we investigated success- and procedural complication rates of laser lead extraction procedures in single versus dual coil leads.
Methods: Between January 2001 and July 2013, 41 single coil and 145 dual coil ICD leads were treated in 171 patients using SLS II 40 Hz- or GlideLight 80 Hz laser sheaths. Indications for lead removals were pocket infection (35.7%), septicaemia or endocarditis (18.1%), lead dysfunction (43.3%), venous occlusion (1.2%), lead migration (0.6%) and chronic pain (1.2%). Data on procedural success rates, intra- and postoperative outcomes, as well as 30-day mortality were collected into a database and retrospectively analyzed.
Results: Mean patient's age was 58.2 ± 16.1 years, and 70.8% were male. Mean time from initial lead implantation was 50.3 ± 18.4 and 45.8 ± 14.5 months in single coil- and dual coil group respectively (p = 0.1). Mean laser treatment time was 1.8 ± 1.5 for single coil group and 2.5 ± 1.2 min in dual coil group (p = 0.002). In group of single coil leads, 39 out of 41 leads (95.1%) were completely removed, partial removal was achieved in 2 (4.9%) leads and no failure of extraction occurred. In group of patients with dual coil leads rate of complete- and partial removal was 94.5% (n = 137) and 4.1% (n = 6), failure rate was 1.4% showing no statistically significant differences compared to single coil group. Overall complication rate was 2.7% in single- and 3.7% in dual coil group respectively (p = 1.0). In single coil patients one major (2.7%) and no minor complication occurred, while in dual coil group one major and four minor complications occurred. No significant p-values were observed. During 30-day follow-up no death occurred in any of the groups.
Conclusion: Laser lead extraction allows for safe and effective removal of ICD leads. Compared to single coil leads, the extraction of dual coil leads is associated with longer laser treatment times but without statistically significant differences in complication- and procedural success rates.