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J Am Coll Cardiol. 2010 Feb 9;55(6):579-86. doi: 10.1016/j.jacc.2009.08.070.

Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions.

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1
Department of Cardiovascular Disease, Cleveland Clinic, Cleveland, Ohio 44195, USA. waznio@ccf.org

Erratum in

  • J Am Coll Cardiol. 2010 Mar 9;55(10):1055.

Abstract

OBJECTIVES:

This study 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.

BACKGROUND:

The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices.

METHODS:

Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included.

RESULTS:

Between 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/m(2) 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/m(2). 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 > or =2.0. Indicators of all-cause in-hospital mortality were pocket infections, device-related endocarditis, diabetes, and creatinine > or =2.0.

CONCLUSIONS:

Lead extraction 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/m(2). Centers with smaller case volumes tended to have a lower rate of successful extraction.

PMID:
20152562
DOI:
10.1016/j.jacc.2009.08.070
[Indexed for MEDLINE]
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