Author/Authors :
Wazni، نويسنده , , Oussama and Epstein، نويسنده , , Laurence M. and Carrillo، نويسنده , , Roger G. and Love، نويسنده , , Charles H. Adler، نويسنده , , Stuart W. and Riggio، نويسنده , , David W. and Karim، نويسنده , , Shahzad S. and Bashir، نويسنده , , Jamil and Greenspon، نويسنده , , Arnold J. and DiMarco، نويسنده , , John P. and Cooper، نويسنده , , Joshua M. and Onufer، نويسنده , , John R. and Ellenbogen، نويسنده , , Kenneth A. and Kutalek، نويسنده , , Stephen P. and Dentry-Mabry، نويسنده , , Sherri and Ervin، نويسنده , , Carolyn M. and Wilkoff، نويسنده , , Bruce L.، نويسنده ,
Abstract :
Objectives
tudy sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients.
ound
ed for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices.
s
utive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included.
s
n January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the time, with a 97.7% clinical success rate whereby clinical goals associated with the indication for lead removal were achieved. Failure to achieve clinical success was associated with body mass index <25 kg/m2 and low extraction volume centers. Procedural failure was higher in leads implanted for >10 years and when performed in low volume centers. Major adverse events in 20 patients were directly related to the procedure (1.4%) including 4 deaths (0.28%). Major adverse effects were associated with patients with a body mass index <25 kg/m2. Overall all-cause in-hospital mortality was 1.86%; 4.3% when associated with endocarditis, 7.9% when associated with endocarditis and diabetes, and 12.4% when associated with endocarditis and creatinine ≥2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine ≥2.0.
sions
xtraction employing laser sheaths is highly successful with a low procedural complication rate. Total mortality is substantially increased with pocket infections or device-related endocarditis, particularly in the setting of diabetes, renal insufficiency, or body mass index <25 kg/m2. Centers with smaller case volumes tended to have a lower rate of successful extraction.
Keywords :
Leads , extraction , Laser , cardiac implantable electronic devices
